Objective To examine the role and mechanism of clopidogrel in the development of salt-sensitive hypertension.Methods 8-week-old Dahl salt-sensitive(Dahl SS)rats and control salt-resistant(SS13BN)rats were divided randomly into six groups and fed for 8 weeks with normal salt(0.4％NaCl,NS),high salt(8％NaCl,HS),or high salt combined with clopidogrel gavage(8％NaCl+10 mg/(kg·d))clopidogrel,HS+CLO).Arterial systolic blood pressure was measured continuously over 8 weeks by the tail-cuff method,and systolic blood pressure was measured by carotid cannulation after 8 weeks(56 days).Renal histopathology was observed by hematoxylin and eosin staining,and renal inflammatory cell infiltration was detected by immunohistochemistry.Peripheral blood platelet activation and platelet-leukocyte aggregation were analyzed by flow cytometry,and the renal inflammation-related proteins tumor necrosis factor-α,interleukin(IL)-1β,IL-6,and key proteins in the p38MAPK/nuclear factor(NF)-κB signaling pathway were detected by Western blot.Results Compared with the NS group,Dahl SS HS rats had significantly increased blood pressure(P＜0.05),aggravated renal tissue damage,increased inflammatory cell infiltration,increased expression of inflammatory cytokines(P＜0.05),elevated peripheral blood platelet activation(P＜0.05)and platelet-leukocyte aggregation(P＜0.05),and increased expression of p38MAPK/NF-κB signaling pathway proteins(P＜0.05).Clopidogrel effectively alleviated these phenotypes induced by high salt in Dahl SS rats.Conclusions Clopidogrel alleviated high-salt-induced salt-sensitive hypertension and decreased renal inflammatory responses and dysfunction in Dahl SS rats by inhibiting platelet activation and the p38MAPK/NF-κB signaling pathway.

This paper reported a case of severe lupus nephritis in an adolescent with progressive hemolytic anemia, thrombocytopenia, and multiple organs involvement, in which renal damage was characterized by sustained elevation of serum creatinine and oliguria. Accurate diagnosis of lupus nephritis complicated with thrombotic microangiopathy was achieved through genetic testing and molecular technology. The use of double filtration plasmapheresis, blocking B-cell targets and complement activation targets, and supplementing frozen plasma provided more accurate, safe and effective treatment options for patients, which significantly improved prognosis.

Objective:To investigate the feasibility and value of nomogram based on base line clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics for pretreatment predicting the depth of myometrial invasion and tumor grade of endometrioid endometrial carcinoma (EEC).Methods:Preoperative baseline clinical characteristics and DCE-MRI characteristics of 194 EEC patients were prospectively collected at Obstetrics and Gynecology Hospital, Fudan University from October 2020 to January 2022 and used as a training set. Univariate analysis was conducted to compare baseline clinical characteristics and DCE-MRI quantitative parameters [including tumor volume, and mean, median, and standard deviation of volume transfer constant (K trans), rate constant (K ep), extravascular extracellular volume fraction (V e), and initial area under the enhancement curve (iAUC)] between patients with deep myometrial invasion (DMI) and those with superficial myometrial invasion (SMI), as well as between high-grade and low-grade EEC. Multivariate logistics regression analysis was used to identify independent predictors for the construction of nomogram. An independent external testing set comprising 127 EEC patients was retrospectively collected from Zhongshan Hospital, Fudan University and Zhongshan Hospital, Fudan University (Xiamen Branch). The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used for evaluating the model′s predictive performance and clinical net benefit, respectively. Results:(1) The depth of myometrial invasion: univariate analysis showed that in the training set, the EEC patients with DMI differed significantly from those with SMI in clinical characteristics including higher proportion of postmenopausal state and overweight [body mass index (BMI)≥25 kg/m2], and abnormal levels of serum cancer antigen (CA) 125, CA 199, and human epididymis protein 4 (HE4), and in DCE-MRI quantitative parameters including tumor volume, and median, mean, and standard deviation of K trans, median of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, CA 199, tumor volume, and mean of iAUC were independent predictors of the depth of myometrial invasion, and constructed the nomogram (recorded as Nomogram_1), achieving an AUC of 0.861 (95% CI: 0.803-0.919) in the training set. In the independent external testing set, the AUC was 0.876 (95% CI: 0.815-0.938), with corresponding sensitivity of 82.0%, specificity of 80.7%, accuracy of 81.1%, positive predictive value (PPV) of 65.3%, and negative predictive value (NPV) of 91.0% for predicting DMI. (2) The EEC grade: univariate analysis showed that in the training set, high-grade EEC patients differed significantly from low-grade EEC in clinical characteristics including patient′s age, the proportion of postmenopausal state and overweight, and abnormal levels of serum CA 125, and in DCE-MRI quantitative parameters including tumor volume, median, mean, and standard deviation of K trans, median and mean of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, tumor volume, and median of V e emerged as independent predictors of EEC grade, and constructed the nomogram (recorded as Nomogram_2), achieving an AUC of 0.845 (95% CI: 0.786-0.893) in the training set. While in the external testing set, the AUC was 0.819 (95% CI: 0.744-0.894), with corresponding sensitivity of 72.4%, specificity of 72.4%, accuracy of 72.4%, PPV of 43.8%, and NPV of 89.9% for predicting high-grade EEC. (3) The DCA curves demonstrated that both Nomogram_1 and Nomogram_2 yielded obvious positive clinical net benefits across a wide range of threshold probabilities. Conclusion:The nomogram based on pretreatment clinical and DCE-MRI characteristics has the potential to noninvasive predict the depth of myometrial invasion and grade of EEC, providing valuable reference information for clinical management decision-making.

Objective To understand the clinical characteristics of patients with Streptococcus anginosus group(SAG)pulmonary abscess and resistance of SAG.Methods 67 patients with pulmonary abscess admitted to a hos-pital from January 2018 to May 2022 were retrospectively analyzed,clinical data of patients with SAG pulmonary abscess were analyzed,and the minimum inhibitory concentration of antimicrobial agents to 18 SAG strains was de-tected by microbroth dilution method,the carriage of resistance genes and virulence genes of SAG were detected by high-throughput sequencing technology.Results Among 67 patients with pulmonary abscess,SAG accounted for 29.9％(20/67),out of which 2 were excluded due to bacterial inactivation,and 18 patients were included for fur-ther studies.18 patients with SAG pulmonary abscess were all community acquired,with an average age of(60.9±9.1)years.There were 13(72.2％)male patients,most patients(94.4％)complicated chronic pulmonary disease,with cough(94.4％)and expectoration(88.9％)as the initial symptoms,some patients(44.4％)had chest pain,and more than half(61.1％)didn't have fever.The proportion of neutrophils,erythrocyte sedimentation rate,and C-reactive protein were mostly elevated,while procalcitonin was normal.The resistance rate of 18 SAG strains to erythromycin,clindamycin,and tetracycline was＞65％,out of which 14 strains carried resistance gene ermB,13 strains carried resistance gene tetM,and 1 strain carried both resistance gene msrD and mefA.18 SAG strains were detected virulence gene psaA,out of which 3 strains were detected virulence gene nan A.Conclusion SAG is an im-portant pathogen that causes pulmonary abscess,and the patients'complications are mainly chronic pulmonary di-seases,with non-specific clinical manifestations;Most strains carry ermB and tetM genes,mediating resistance to macrolides,lincosamides,and tetracyclines.

Objective To investigate the current status of patient safety culture among health professionals in tertia-ry public hospitals in Heilongjiang Province,explore the correlation between patient safety culture and adverse event reporting barriers in medical quality(safety),and discuss feasible strategies to improve the reporting rate of adverse events,providing valuable references for promoting the high-quality development of public hospitals and ensuring pa-tient safety.Methods Questionnaires were randomly distributed to the on-the-job employees of three Grade-A hospi-tals in Heilongjiang Province,and 200 copies were distributed to each hospital.The contents of the survey included:sociodemographic characteristics questionnaire,adverse event reporting disorder scale and patient safety culture scale,t-test and analysis of variance were used for univariate analysis,Pearson analysis was used for correlation test,and multiple linear regression was used to analyze the influencing factors of adverse event reporting obstacles.Results The barriers to adverse event reporting are negatively correlated with the total score and each dimension scores of the patient safety culture assessment scale(P＜0.05).Factors influencing the barriers to adverse event re-porting include marital status,work department,whether it is involve in university teaching duties,and whether it is served as a postgraduate supervisor,and the differences were statistically significant(P＜0.05).Conclusion Hospi-tals should align with national and provincial policies,strengthen the construction of safety culture systems and mechanisms,focus on non-medical factors,enhance doctors'awareness of adverse event reporting,improve management team building,and refine the adverse event management chain.

Objective To examine the role and mechanism of clopidogrel in the development of salt-sensitive hypertension.Methods 8-week-old Dahl salt-sensitive(Dahl SS)rats and control salt-resistant(SS13BN)rats were divided randomly into six groups and fed for 8 weeks with normal salt(0.4％NaCl,NS),high salt(8％NaCl,HS),or high salt combined with clopidogrel gavage(8％NaCl+10 mg/(kg·d))clopidogrel,HS+CLO).Arterial systolic blood pressure was measured continuously over 8 weeks by the tail-cuff method,and systolic blood pressure was measured by carotid cannulation after 8 weeks(56 days).Renal histopathology was observed by hematoxylin and eosin staining,and renal inflammatory cell infiltration was detected by immunohistochemistry.Peripheral blood platelet activation and platelet-leukocyte aggregation were analyzed by flow cytometry,and the renal inflammation-related proteins tumor necrosis factor-α,interleukin(IL)-1β,IL-6,and key proteins in the p38MAPK/nuclear factor(NF)-κB signaling pathway were detected by Western blot.Results Compared with the NS group,Dahl SS HS rats had significantly increased blood pressure(P＜0.05),aggravated renal tissue damage,increased inflammatory cell infiltration,increased expression of inflammatory cytokines(P＜0.05),elevated peripheral blood platelet activation(P＜0.05)and platelet-leukocyte aggregation(P＜0.05),and increased expression of p38MAPK/NF-κB signaling pathway proteins(P＜0.05).Clopidogrel effectively alleviated these phenotypes induced by high salt in Dahl SS rats.Conclusions Clopidogrel alleviated high-salt-induced salt-sensitive hypertension and decreased renal inflammatory responses and dysfunction in Dahl SS rats by inhibiting platelet activation and the p38MAPK/NF-κB signaling pathway.

Objective:To investigate the feasibility and value of nomogram based on base line clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics for pretreatment predicting the depth of myometrial invasion and tumor grade of endometrioid endometrial carcinoma (EEC).Methods:Preoperative baseline clinical characteristics and DCE-MRI characteristics of 194 EEC patients were prospectively collected at Obstetrics and Gynecology Hospital, Fudan University from October 2020 to January 2022 and used as a training set. Univariate analysis was conducted to compare baseline clinical characteristics and DCE-MRI quantitative parameters [including tumor volume, and mean, median, and standard deviation of volume transfer constant (K trans), rate constant (K ep), extravascular extracellular volume fraction (V e), and initial area under the enhancement curve (iAUC)] between patients with deep myometrial invasion (DMI) and those with superficial myometrial invasion (SMI), as well as between high-grade and low-grade EEC. Multivariate logistics regression analysis was used to identify independent predictors for the construction of nomogram. An independent external testing set comprising 127 EEC patients was retrospectively collected from Zhongshan Hospital, Fudan University and Zhongshan Hospital, Fudan University (Xiamen Branch). The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used for evaluating the model′s predictive performance and clinical net benefit, respectively. Results:(1) The depth of myometrial invasion: univariate analysis showed that in the training set, the EEC patients with DMI differed significantly from those with SMI in clinical characteristics including higher proportion of postmenopausal state and overweight [body mass index (BMI)≥25 kg/m2], and abnormal levels of serum cancer antigen (CA) 125, CA 199, and human epididymis protein 4 (HE4), and in DCE-MRI quantitative parameters including tumor volume, and median, mean, and standard deviation of K trans, median of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, CA 199, tumor volume, and mean of iAUC were independent predictors of the depth of myometrial invasion, and constructed the nomogram (recorded as Nomogram_1), achieving an AUC of 0.861 (95% CI: 0.803-0.919) in the training set. In the independent external testing set, the AUC was 0.876 (95% CI: 0.815-0.938), with corresponding sensitivity of 82.0%, specificity of 80.7%, accuracy of 81.1%, positive predictive value (PPV) of 65.3%, and negative predictive value (NPV) of 91.0% for predicting DMI. (2) The EEC grade: univariate analysis showed that in the training set, high-grade EEC patients differed significantly from low-grade EEC in clinical characteristics including patient′s age, the proportion of postmenopausal state and overweight, and abnormal levels of serum CA 125, and in DCE-MRI quantitative parameters including tumor volume, median, mean, and standard deviation of K trans, median and mean of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, tumor volume, and median of V e emerged as independent predictors of EEC grade, and constructed the nomogram (recorded as Nomogram_2), achieving an AUC of 0.845 (95% CI: 0.786-0.893) in the training set. While in the external testing set, the AUC was 0.819 (95% CI: 0.744-0.894), with corresponding sensitivity of 72.4%, specificity of 72.4%, accuracy of 72.4%, PPV of 43.8%, and NPV of 89.9% for predicting high-grade EEC. (3) The DCA curves demonstrated that both Nomogram_1 and Nomogram_2 yielded obvious positive clinical net benefits across a wide range of threshold probabilities. Conclusion:The nomogram based on pretreatment clinical and DCE-MRI characteristics has the potential to noninvasive predict the depth of myometrial invasion and grade of EEC, providing valuable reference information for clinical management decision-making.

Objective To understand the clinical characteristics of patients with Streptococcus anginosus group(SAG)pulmonary abscess and resistance of SAG.Methods 67 patients with pulmonary abscess admitted to a hos-pital from January 2018 to May 2022 were retrospectively analyzed,clinical data of patients with SAG pulmonary abscess were analyzed,and the minimum inhibitory concentration of antimicrobial agents to 18 SAG strains was de-tected by microbroth dilution method,the carriage of resistance genes and virulence genes of SAG were detected by high-throughput sequencing technology.Results Among 67 patients with pulmonary abscess,SAG accounted for 29.9％(20/67),out of which 2 were excluded due to bacterial inactivation,and 18 patients were included for fur-ther studies.18 patients with SAG pulmonary abscess were all community acquired,with an average age of(60.9±9.1)years.There were 13(72.2％)male patients,most patients(94.4％)complicated chronic pulmonary disease,with cough(94.4％)and expectoration(88.9％)as the initial symptoms,some patients(44.4％)had chest pain,and more than half(61.1％)didn't have fever.The proportion of neutrophils,erythrocyte sedimentation rate,and C-reactive protein were mostly elevated,while procalcitonin was normal.The resistance rate of 18 SAG strains to erythromycin,clindamycin,and tetracycline was＞65％,out of which 14 strains carried resistance gene ermB,13 strains carried resistance gene tetM,and 1 strain carried both resistance gene msrD and mefA.18 SAG strains were detected virulence gene psaA,out of which 3 strains were detected virulence gene nan A.Conclusion SAG is an im-portant pathogen that causes pulmonary abscess,and the patients'complications are mainly chronic pulmonary di-seases,with non-specific clinical manifestations;Most strains carry ermB and tetM genes,mediating resistance to macrolides,lincosamides,and tetracyclines.

Objective To investigate the current status of patient safety culture among health professionals in tertia-ry public hospitals in Heilongjiang Province,explore the correlation between patient safety culture and adverse event reporting barriers in medical quality(safety),and discuss feasible strategies to improve the reporting rate of adverse events,providing valuable references for promoting the high-quality development of public hospitals and ensuring pa-tient safety.Methods Questionnaires were randomly distributed to the on-the-job employees of three Grade-A hospi-tals in Heilongjiang Province,and 200 copies were distributed to each hospital.The contents of the survey included:sociodemographic characteristics questionnaire,adverse event reporting disorder scale and patient safety culture scale,t-test and analysis of variance were used for univariate analysis,Pearson analysis was used for correlation test,and multiple linear regression was used to analyze the influencing factors of adverse event reporting obstacles.Results The barriers to adverse event reporting are negatively correlated with the total score and each dimension scores of the patient safety culture assessment scale(P＜0.05).Factors influencing the barriers to adverse event re-porting include marital status,work department,whether it is involve in university teaching duties,and whether it is served as a postgraduate supervisor,and the differences were statistically significant(P＜0.05).Conclusion Hospi-tals should align with national and provincial policies,strengthen the construction of safety culture systems and mechanisms,focus on non-medical factors,enhance doctors'awareness of adverse event reporting,improve management team building,and refine the adverse event management chain.

This paper reported a case of severe lupus nephritis in an adolescent with progressive hemolytic anemia, thrombocytopenia, and multiple organs involvement, in which renal damage was characterized by sustained elevation of serum creatinine and oliguria. Accurate diagnosis of lupus nephritis complicated with thrombotic microangiopathy was achieved through genetic testing and molecular technology. The use of double filtration plasmapheresis, blocking B-cell targets and complement activation targets, and supplementing frozen plasma provided more accurate, safe and effective treatment options for patients, which significantly improved prognosis.