To investigate the association between neutrophil to lymphocyte ratio (NLR) andestimated glomerular filtration rate (eGFR) in patients with diabetes using large-scale data.

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 31-year-old man sought medical evaluation for a 2-year history of edema and proteinuria, with prior pathology suggesting atypical membranous nephropathy (MN). Despite treatment with a combination of steroids, calcineurin inhibitors, and four courses of rituximab (1 g, intravenous injection), the patient′s nephrotic syndrome showed no relief (24 h urine protein peaked at 31.18 g/d), indicating refractory nephrotic syndrome. Later in the disease course, a sudden surge of creatinine level (322.5 μmol/L) prompted a renal biopsy, which revealed concurrent acute interstitial nephritis. Further treatment involving steroids, cyclophosphamide, and a fifth rituximab infusion (1 g, intravenous injection) resulted in improvement in renal function (serum creatinine: 322.5?147 μmol/L), but the MN failed to achieve partial relief. Subsequent treatment with the novel humanized CD20 monoclonal antibody obinutuzumab (1 g, intravenous injection) was initiated. In the latest follow-up, anti-phospholipase-A2-receptor antibody (PLA2R) antibody were negative, B cells were eliminated, serum albumin was 36 g/L, urine protein-to-creatinine ratio was 4 810 mg/g, and serum creatinine was 162 μmol/L. This case underscores the potential efficacy of obinutuzumab in refractory MN. For advanced MN cases, prompt identification of the cause of acute kidney injury is crucial, emphasizing the need for targeted interventions to potentially stall renal function decline.

Objective:To explore the impact of intradialytic hypotension (IDH) on brain component volume, as well as its relationship with depression and cognitive function changes in maintenance hemodialysis patients.Method:It was a cross-sectional observational study. Clinical data of 119 patients under maintenance hemodialysis in Peking Union Medical College Hospital from July 2013 to July 2014 were collected, retrospectively. Patients were divided into IDH group and non-IDH group. 3.0T Magnetic resonance imaging examination of the head for all patients was completed and the results of volume analysis of each component of the brain were extracted. Cognitive function was assessed by the Chinese version of the simplified mental state examination scale (C-MMSE) and the Chinese version of the Montreal cognitive assessment scale (C-MoCA). Depressive status was assessed by the Hamilton depression scale 17 (HAMD_17) and living ability was assessed by the Alzheimer's disease collaborative study-daily living ability assessment questionnaire. In addition, the Philadelphia word learning test was used to measure memory, the Boston naming test to measure language, the connection test A and B to measure executive ability, and the Stroup test C to measure attention. The differences in brain component volume, cognitive function, emotion, and life ability between two groups of patients were compared, and the correlation between IDH and brain component volume was explored by regression analysis.Result:A total of 119 patients were included in this study, of whom 22 (18.5%) had hypotension during dialysis. The volumes of amygdala, cuneiform lobe, and posterior cingulate gyrus in IDH group were significantly smaller than those in the non-hypotension group [ (1.6±0.2) mm 3vs. (1.7±0.2) mm 3, t=2.674, P=0.009; (6.9±0.8) mm 3vs. (7.4±1.0) mm 3, t=2.187, P=0.031; (6.9±0.8) mm 3vs. (7.4±0.9) mm 3, t=2.252, P=0.024]. The differences of gray matter, white matter volume between the two groups showed a similar trend but did not reach statistical significance. And lacunar infarction and cerebral microbleeds were more common in IDH group. The daily living ability scores of the two groups were similar (65.51±11.52 vs. 65.71±11.53, Z=-0.456, P=0.648). The proportion of patients with cognitive abnormalities was higher in the IDH group, without statistical significance. The proportion of depression was similar. Univariate linear regression analysis showed that IDH was significantly negatively correlated with the volume of amygdala, cuneiform cortex, and posterior cingulate gyrus, which control emotions in the brain ( B=-0.117, 95% CI -0.203--0.030, P=0.009; B=-0.484, 95% CI -0.923--0.046, P=0.031; B=-0.485, 95% CI -0.911--0.058, P=0.026). After multivariate adjustment, decreased amygdala volume was still correlated with IDH ( B=-0.111, 95% CI -0.198--0.025, P=0.026). Conclusion:Recurrent IDH may lead to atrophy of various brain components, which may be one of the reasons for cognitive and emotional changes in maintenance hemodialysis patients.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

AIM: To prepare radix scutellariae microemulsion gel and investigate its therapeutic effect on chronic eczema based on the previous research of radix scutellariae self microemulsion. METHODS: The gel matrix and humectant were optimized by single factor method and response surface method to obtain the formula and preparation technique of the gel. The Franz diffusion cell method was used to evaluate the transdermal properties of microemulsion and microemulsion gel in vitro. By establishing a chronic eczema model in the mouse ear, the swelling degree, swelling inhibition rate, pathological changes and tumor necrosis factor α (TNF-α), Interleukin-1β (IL-1β) and interleukin - 6 (IL-6) of radix scutellariae microemulsion gel were measured, to investigate the therapeutic effect on chronic eczema in mice. RESULTS: The physical and chemical properties of radix scutellariae microemulsion gel were stable. Compared with microemulsion, the microemulsion gel had better transdermal performance. The cumulative transdermal amount of baicalein and wogonin, the main components of microemulsion gel, was 1.85 times and 2.77 times of that of microemulsion respectively. Moreover, the steady flow rate and permeability coefficient of microemulsion gel significantly increased, and the lag time significantly shortened. Pharmacodynamic study showed that compared with the model group, the radix scutellariae microemulsion gel could significantly reduce the ear swelling of mice (P<0.05), and the serum inflammatory factor TNF - α, IL-1β and IL-6 reduced content by over 37%. Compared with the radix scutellaria aqueous extract and aqueous extract gel, the treatment of chronic eczema was better. CONCLUSION: The preparation process of radix scutellaria microemulsion gel is feasible, with strong transdermal property, and a significant therapeutic effect on chronic eczema.

AIM:To prepare radix scutellariae mi-croemulsion gel and investigate its therapeutic ef-fect on chronic eczema based on the previous re-search of radix scutellariae self microemulsion.METHODS:The gel matrix and humectant were op-timized by single factor method and response sur-face method to obtain the formula and preparation technique of the gel.The Franz diffusion cell meth-od was used to evaluate the transdermal proper-ties of microemulsion and microemulsion gel in vi-tro.By establishing a chronic eczema model in the mouse ear,the swelling degree,swelling inhibition rate,pathological changes and tumor necrosis fac-tor a(TNF-a),Interleukin-1β(IL-1β)and interleukin-6(IL-6)of radix scutellariae microemulsion gel were measured,to investigate the therapeutic ef-fect on chronic eczema in mice.RESULTS:The physi-cal and chemical properties of radix scutellariae mi-croemulsion gel were stable.Compared with micro-emulsion,the microemulsion gel had better trans-dermal performance.The cumulative transdermal amount of baicalein and wogonin,the main compo-nents of microemulsion gel,was 1.85 times and 2.77 times of that of microemulsion respectively.Moreover,the steady flow rate and permeability co-efficient of microemulsion gel significantly in-creased,and the lag time significantly shortened.Pharmacodynamic study showed that compared with the model group,the radix scutellariae micro-emulsion gel could significantly reduce the ear swelling of mice(P＜0.05),and the serum inflamma-tory factor TNF-a,IL-1β and IL-6 reduced content by over 37％.Compared with the radix scutellaria aqueous extract and aqueous extract gel,the treat-ment of chronic eczema was better.CONCLUSION:The preparation process of radix scutellaria micro-emulsion gel is feasible,with strong transdermal property,and a significant therapeutic effect on chronic eczema.

AIM:To prepare radix scutellariae mi-croemulsion gel and investigate its therapeutic ef-fect on chronic eczema based on the previous re-search of radix scutellariae self microemulsion.METHODS:The gel matrix and humectant were op-timized by single factor method and response sur-face method to obtain the formula and preparation technique of the gel.The Franz diffusion cell meth-od was used to evaluate the transdermal proper-ties of microemulsion and microemulsion gel in vi-tro.By establishing a chronic eczema model in the mouse ear,the swelling degree,swelling inhibition rate,pathological changes and tumor necrosis fac-tor a(TNF-a),Interleukin-1β(IL-1β)and interleukin-6(IL-6)of radix scutellariae microemulsion gel were measured,to investigate the therapeutic ef-fect on chronic eczema in mice.RESULTS:The physi-cal and chemical properties of radix scutellariae mi-croemulsion gel were stable.Compared with micro-emulsion,the microemulsion gel had better trans-dermal performance.The cumulative transdermal amount of baicalein and wogonin,the main compo-nents of microemulsion gel,was 1.85 times and 2.77 times of that of microemulsion respectively.Moreover,the steady flow rate and permeability co-efficient of microemulsion gel significantly in-creased,and the lag time significantly shortened.Pharmacodynamic study showed that compared with the model group,the radix scutellariae micro-emulsion gel could significantly reduce the ear swelling of mice(P＜0.05),and the serum inflamma-tory factor TNF-a,IL-1β and IL-6 reduced content by over 37％.Compared with the radix scutellaria aqueous extract and aqueous extract gel,the treat-ment of chronic eczema was better.CONCLUSION:The preparation process of radix scutellaria micro-emulsion gel is feasible,with strong transdermal property,and a significant therapeutic effect on chronic eczema.

AIM:To prepare radix scutellariae mi-croemulsion gel and investigate its therapeutic ef-fect on chronic eczema based on the previous re-search of radix scutellariae self microemulsion.METHODS:The gel matrix and humectant were op-timized by single factor method and response sur-face method to obtain the formula and preparation technique of the gel.The Franz diffusion cell meth-od was used to evaluate the transdermal proper-ties of microemulsion and microemulsion gel in vi-tro.By establishing a chronic eczema model in the mouse ear,the swelling degree,swelling inhibition rate,pathological changes and tumor necrosis fac-tor a(TNF-a),Interleukin-1β(IL-1β)and interleukin-6(IL-6)of radix scutellariae microemulsion gel were measured,to investigate the therapeutic ef-fect on chronic eczema in mice.RESULTS:The physi-cal and chemical properties of radix scutellariae mi-croemulsion gel were stable.Compared with micro-emulsion,the microemulsion gel had better trans-dermal performance.The cumulative transdermal amount of baicalein and wogonin,the main compo-nents of microemulsion gel,was 1.85 times and 2.77 times of that of microemulsion respectively.Moreover,the steady flow rate and permeability co-efficient of microemulsion gel significantly in-creased,and the lag time significantly shortened.Pharmacodynamic study showed that compared with the model group,the radix scutellariae micro-emulsion gel could significantly reduce the ear swelling of mice(P＜0.05),and the serum inflamma-tory factor TNF-a,IL-1β and IL-6 reduced content by over 37％.Compared with the radix scutellaria aqueous extract and aqueous extract gel,the treat-ment of chronic eczema was better.CONCLUSION:The preparation process of radix scutellaria micro-emulsion gel is feasible,with strong transdermal property,and a significant therapeutic effect on chronic eczema.

AIM:To prepare radix scutellariae mi-croemulsion gel and investigate its therapeutic ef-fect on chronic eczema based on the previous re-search of radix scutellariae self microemulsion.METHODS:The gel matrix and humectant were op-timized by single factor method and response sur-face method to obtain the formula and preparation technique of the gel.The Franz diffusion cell meth-od was used to evaluate the transdermal proper-ties of microemulsion and microemulsion gel in vi-tro.By establishing a chronic eczema model in the mouse ear,the swelling degree,swelling inhibition rate,pathological changes and tumor necrosis fac-tor a(TNF-a),Interleukin-1β(IL-1β)and interleukin-6(IL-6)of radix scutellariae microemulsion gel were measured,to investigate the therapeutic ef-fect on chronic eczema in mice.RESULTS:The physi-cal and chemical properties of radix scutellariae mi-croemulsion gel were stable.Compared with micro-emulsion,the microemulsion gel had better trans-dermal performance.The cumulative transdermal amount of baicalein and wogonin,the main compo-nents of microemulsion gel,was 1.85 times and 2.77 times of that of microemulsion respectively.Moreover,the steady flow rate and permeability co-efficient of microemulsion gel significantly in-creased,and the lag time significantly shortened.Pharmacodynamic study showed that compared with the model group,the radix scutellariae micro-emulsion gel could significantly reduce the ear swelling of mice(P＜0.05),and the serum inflamma-tory factor TNF-a,IL-1β and IL-6 reduced content by over 37％.Compared with the radix scutellaria aqueous extract and aqueous extract gel,the treat-ment of chronic eczema was better.CONCLUSION:The preparation process of radix scutellaria micro-emulsion gel is feasible,with strong transdermal property,and a significant therapeutic effect on chronic eczema.