A 15-year-old boy developed abdominal pain and melena two weeks after COVID-19 infection, which was followed by gross hematuria and proteinuria. Laboratory studies revealed significantly elevated inflammatory markers. Endoscopic examinations showed multiple jejunal and ileal ulcers. Renal biopsy suggested mesangial proliferative glomerulonephritis with crescent formation, necrosis of capillary loops, and mesangial IgA deposits. IgA vasculitis without purpura was considered as a possible diagnosis, and the treatment with prednisone led to remission of both gastrointestinal and renal diseases.

A 15-year-old boy developed abdominal pain and melena two weeks after COVID-19 infection, which was followed by gross hematuria and proteinuria. Laboratory studies revealed significantly elevated inflammatory markers. Endoscopic examinations showed multiple jejunal and ileal ulcers. Renal biopsy suggested mesangial proliferative glomerulonephritis with crescent formation, necrosis of capillary loops, and mesangial IgA deposits. IgA vasculitis without purpura was considered as a possible diagnosis, and the treatment with prednisone led to remission of both gastrointestinal and renal diseases.

Membranous nephropathy(MN)is the predominant cause of primary nephrotic syn-drome(NS)among adults.The identification of PLA2R as target antigen has brought about a pro-found transformation in the management of MN,offering a basis for the utilization of B-cell deplet-ing agents such as rituximab(RTX).The question of whether early intervention targeting antibodies can effectively impede the progression of MN,contrib-uting to enhanced disease control and long-term renal outcomes for patients,remains further explo-ration.We analyzed demographic data,laboratory parameters,and renal involvement in 13 patients with PLA2R antibody-related MN who received at least one RTX treatment at our center from Octo-ber 2019 to March 2023.Early-stage medium-to-high-risk MN was defined as baseline or admission anti-PLA2R antibody levels exceeding 50 RU/mL,ex-cluding patients who already presented with ne-phrotic syndrome at baseline.The median duration of MN at the initiation of the first RTX treatment was 4.1 months(IQR 1-7.7),and the median follow-up time after RTX therapy was 27 months(IQR 23-45).All patients had commenced renin-angiotensin system inhibitors before receiving RTX.Following RTX therapy,none of the 13 patients progressed to NS during the follow-up period,and 12 patients achieved complete or partial remission at the 2-year follow-up or the last visit.No deaths,severe infections,or other serious adverse reactions oc-curred during the follow-up period.In conclusion,RTX demonstrates favorable efficacy and safety in early-stage,medium-to-high-risk MN patients.Initi-ating antibody clearance therapy in these patients may be beneficial for long-term disease control and distant renal outcomes.

A 69-year-old man was treated with adalimumab 80 mg subcutaneously for psoriasis for the first time. Two days later, the patient developed diffuse erythema with pruritus. Because the active stage of psoriasis was not excluded, adalimumab 40 mg subcutaneous injection was continued once a week for 4 times. The patient′s skin erythema and pruritus continued to worsen. After intravenous infusion of methylprednisolone sodium succinate 40 mg/d for 1 week, the systemic erythema and pruritus were slightly relieved, but the condition was repeated after stopping the drug. Urine routine and sediment analysis showed urinary occult blood (+++), 190 red blood cells/μl, urinary protein (+) , and serum creatinine 80 μmol/L. Renal biopsy and skin histopathology suggested IgA nephropathy and psoriasiform dermatitis, respectively. After consultation with dermatologists, erythroderma caused by deterioration of psoriasis was considered. Excluding other factors, it is considered that IgA nephropathy and erythroderma were probably induced by adalimumab. Methotrexate 10 mg per week was given orally and halometasone ointment was used externally. The skin damage in the patient was gradually improved. Hematuria and proteinuria were self-relieved slowly.At one-year of follow-up, the patient′s renal function and urine routine remained normal, and nephropathy and rash did not recur.

A 69-year-old man was treated with adalimumab 80 mg subcutaneously for psoriasis for the first time. Two days later, the patient developed diffuse erythema with pruritus. Because the active stage of psoriasis was not excluded, adalimumab 40 mg subcutaneous injection was continued once a week for 4 times. The patient′s skin erythema and pruritus continued to worsen. After intravenous infusion of methylprednisolone sodium succinate 40 mg/d for 1 week, the systemic erythema and pruritus were slightly relieved, but the condition was repeated after stopping the drug. Urine routine and sediment analysis showed urinary occult blood (+++), 190 red blood cells/μl, urinary protein (+) , and serum creatinine 80 μmol/L. Renal biopsy and skin histopathology suggested IgA nephropathy and psoriasiform dermatitis, respectively. After consultation with dermatologists, erythroderma caused by deterioration of psoriasis was considered. Excluding other factors, it is considered that IgA nephropathy and erythroderma were probably induced by adalimumab. Methotrexate 10 mg per week was given orally and halometasone ointment was used externally. The skin damage in the patient was gradually improved. Hematuria and proteinuria were self-relieved slowly.At one-year of follow-up, the patient′s renal function and urine routine remained normal, and nephropathy and rash did not recur.

A 64-year-old female patient received postoperative adjuvant chemotherapy with oxaliplatin and capecitabine after radical resection of rectal cancer for rectal adenocarcinoma with multiple lung metastases. Due to poor therapeutic effect, the patient was switched to anlotinib treatment at a dose of 12 mg/d orally for 2 weeks with a 1-week break and 3 weeks was one cycle. During the second cycle of anlotinib treatment, the patient developed edema, proteinuria, hypertension, and hypoalbuminemia, with normal serum creatinine. The renal pathology suggested renal thrombotic microangiopathy, which was in line with the clinical and pathological manifestations of drug-related renal injury due to anti-vascular endothelial growth factor. After discontinuation of anlotinib and receiving symptomatic treatment such as blood pressure control, the edema gradually subsided along with remission of proteinuria. Three months later, the patient had no proteinuria and the serum albumin was normal.

A 64-year-old female patient received postoperative adjuvant chemotherapy with oxaliplatin and capecitabine after radical resection of rectal cancer for rectal adenocarcinoma with multiple lung metastases. Due to poor therapeutic effect, the patient was switched to anlotinib treatment at a dose of 12 mg/d orally for 2 weeks with a 1-week break and 3 weeks was one cycle. During the second cycle of anlotinib treatment, the patient developed edema, proteinuria, hypertension, and hypoalbuminemia, with normal serum creatinine. The renal pathology suggested renal thrombotic microangiopathy, which was in line with the clinical and pathological manifestations of drug-related renal injury due to anti-vascular endothelial growth factor. After discontinuation of anlotinib and receiving symptomatic treatment such as blood pressure control, the edema gradually subsided along with remission of proteinuria. Three months later, the patient had no proteinuria and the serum albumin was normal.

Objective:To investigate the current status of emotional intelligence and conflict management model of emergency department nurses, analyze the correlation between emotional intelligence and conflict management model.Methods:A convenient sampling method was used to investigate on 195 emergency department nurses with general information scale, emotional intelligence scale and conflict management model scale.Results:In the emergency department, the emotional intelligence score of the nurses from high to low was regulation of emotion (3.71±0.67), self-emotion detection (3.55±0.67), use of emotional (3.49±0.70), other people ′s emotion appraisal (3.39±0.60). The most commonly used conflict management mode was integration (3.78±0.62), followed by concession (3.59±0.63), evasion (3.55±0.64), compromise (3.39±0.66), and the least commonly used was dominance (2.55±0.56). Every dimensions of emotional intelligence were correlated with conflict management model positively ( r values were 0.109-0.523, P<0.05 or 0.01), the top predictive factor was emotion detection. Conclusions:The emotional intelligence is an important factor influencing the conflict management mode of nurses in emergency department. Managers should pay attention to improve emergency nurses ′ emotional intelligence and guide them to adopt appropriate conflict management model, which will help alleviate the contradiction between emergency nurses and patients and create a more harmonious emergency care relationship.

Objective To determine the impact of new methods in teaching and examination on students' learning of psychiatry by increasing the proportion of objective questions in the final exam papers through examination reform, so as to help students adapt to the Practitioner Examination. Methods A total of 483 students from grade 2011&2012 were selected as research subjects. Through the comparative study of the test scores under different teaching methods before and after the examination reform, the SPSS 22.0 statistical software was used to analyze the structure, reliability, difficulty and level of differentiation of the examine papers via t tests. Results Examination papers after the reform showed an increase in difficulty in all question types; some question types also had higher levels of differentiation. Students receiving PBL-based education had higher scores compared to those under traditional teaching methods. The difference was statistically significant. Conclusion PBL teaching mode is more conducive to the mastering of knowledge points and helps students improve grades in objective questions. Medical schools should increase the use of PBL teaching reform in psychiatry courses and conduct examination reform, so as to improve the teaching effect and the passing rate of Practitioners Examination.

Objective To evaluate the immunogenicity and safety of a split-virion influenza vac-cine after its manufacturing process was improved. Methods The immunological non-inferiority of trial to control vaccines was evaluated in 240 subjects aged 3-<18 years. Another 360 subjects aged 18-<60 years were randomly divided into three groups that were respectively given three consecutive lots of trail vaccine to assess the consistency of immunogenicity. Results There were 4. 17% of the subjects aged 3-<18 years showed adverse reactions following immunization with trail vaccine and it was not significantly different from that of the control group (P>0. 05). No significant difference in seroconversion rate, geometric mean titer (GMT) of haemagglutination inhibition antibodies(HIAb) or protection rate was found between trial and control groups (P>0. 05). No significant difference in seroconversion rate or HIAb GMT was found among the three lots (P>0. 05). Conclusion The trial influenza vaccine has good safety, immunogenicity and lot-to-lot consistency after the manufacturing process was improved.