Objective:To explore the expression of type 2 complement receptor (CR2) in mesangial cells of the renal tissue in IgA nephropathy (IgAN) and its possible mechanism involved in complement C3 deposition.Methods:The demographic data, samples of plasma and renal tissues of primary IgAN patients diagnosed by renal biopsy in the Guangdong Provincial People's Hospital from August 2021 to May 2022 were collected. According to the fluorescent intensity of mesangial complement C3 deposition, the patients were divided into complement C3 deposition ≥2+ group and complement C3 deposition <2+ group. The circulating IgA and complement C3 levels were detected by enzyme linked immunosorbent assay (ELISA). The influencing factors of kidney prognosis, plasma IgA and complement C3 levels were compared between the two groups. Immunofluorescence was used to detect the expression of IgA, complement C3 and CR2 in the renal mesangial cells of IgAN patients and normal renal tissues around renal carcinoma. Human mesangial cells were cultured in vitro and randomly divided into control group and experimental group. The experimental group was incubated with IgA protein (2 g/L) for 8 hours. The expressions of CR2 protein and mRNA were measured by Western blotting and real-time fluorescence quantitative PCR. The biological function of differential genes was analyzed by gene ontology (GO) and Kyto encyclopedia of genes and genomes (KEGG) enrichment analysis. Results:A total of 75 patients with IgAN were included in this study, including 50 patients in the complement C3 deposition ≥2+ group and 25 patients in the complement C3 deposition <2+ group. The proportions of patients with urine red blood cell count negative, 1+, 2+ and 3+-4+ in the complement C3 deposition ≥2+ group were 2.0%, 8.0%, 18.0% 72.0%, respectively, which were more serious than those in the complement C3 deposition <2+ group (4.0%, 4.0%, 52.0%, 40.0%) ( Z=-2.320, P=0.020). Meanwhile, the proportion of S1 in Oxford pathological classification in the complement C3 deposition ≥2+ group was higher than that in the complement C3 deposition <2+ group (68.0% vs. 40.0%, χ2=5.389, P=0.020), and there were no statistically significant differences in gender, age, 24-hour urinary protein, serum creatinine, other indicators of Oxford pathological classification between the two groups. ELISA results showed that plasma IgA concentration in the complement C3 deposition ≥2+ group was higher than that in the complement C3 deposition <2+ group [3.62 (2.95, 5.53) g/L vs. 2.72 (2.15, 4.24) g/L, Z=2.405, P=0.016], and the plasma complement C3 concentration was lower than that in the complement C3 deposition <2+ group [199.6 (116.0, 328.0) mg/L vs. 319.2 (158.3, 454.5) mg/L, Z=-2.383, P=0.017]. Spearman correlation analysis showed that the complement C3 deposition intensity was positively correlated with IgA deposition intensity in mesangial area ( rs=0.441, P<0.001). Immunofluorescence results showed that there was colocalization of IgA and complement C3 in the glomeruli of IgAN patients. The expression of CR2 in the kidney was consistent with complement C3 deposition, and CR2 was colocalization with complement C3. In vitro experiments, the expression of CR2 in IgA protein group was higher than that in the control group ( P<0.05). GO and KEGG enrichment analysis found that IgA protein induced active changes in various pathways of mesangial cells. Conclusion:IgA protein induces mesangial cells to express CR2 and participates in complement C3 deposition, which may be an important mechanism of complement C3 activation in IgAN.

Objective To evaluate the relationship between low vitamin D level and metabolic syndrome (MS) in maintenance hemodialysis (MHD) patients.Methods A total of 143 patients who had received MHD from Jan 2016 to Jan 2017 in the dialysis center of our hospital were enrolled.Their clinical and laboratory data were collected.The serum 25(OH)D3 levels were measured by chemiluminescence instrument.According to the levels of 25(OH)D3,patients were divided into three groups:sufficient group (＞ 30 μg/L),insufficient group (15-30 μg/L) and deficient group (＜ 15 μg/L) to explore how the 25(OH)D3 were associated with MS and abnormal metabolic parameters,including central obesity,raised triglycerides (TG),reduced high-density lipoprotein cholesterol (HDL-C),raised systolic blood pressure (SBP),raised diastolic blood pressure (DBP) and increased fasting blood glucose (FBG).The risk factors of MS and abnormal metabolic factors were analyzed by multivariate logistic regression model.Results Among the 143 MHD patients,the median of serum 25(OH)D3 was 24.30(12.90,29.50) μg/L and the prevalence of MS was 45.45％(65 cases).Among 3 groups the prevalence of MS,the abdominal circumference and the serum TG showed statistical differences,and they increased with the severity of 25(OH)D3 deficiency (all P ＜ 0.05).The body mass indexes of patients in the insufficient and deficient groups were elevated compared with that in the sufficient group (all P ＜ 0.05).SBP,TG and FBG in deficient group were significantly higher but HDL-C was lower than those in the other two groups (all P ＜ 0.05).The more abnormal metabolism existed,the lower 25(OH)D3 levels patients had (H=61.316,P＜0.001).Multivariate logistic regression analysis showed that in MHD patients low 25(OH)D3 negatively correlated with MS (OR=0.889,95％CI 0.846-0.934,P ＜ 0.001) and abnormal metabolic factors central obesity (OR=0.913,95％CI 0.874-0.953,P ＜ 0.001),raised TG (OR=0.932,95％ CI 0.894-0.971,P=0.001),reduced HDL-C (OR=0.901,95％ CI 0.845-0.959,P=0.001),raised SBP (OR=0.898,95％CI 0.847-0.953,P＜ 0.001) and raised FBG (OR=0.956,95％CI 0.920-0.994,P=0.024).Conclusions The prevalence of MS is high in MHD patients and low levels of 25(OH)D3 may be an independent risk factor for MS and abnormal metabolic factors.

Objective To investigate the possible risk factors for the progression of abdominal aortic calcification (AAC) in MHD patients.Methods Total of 170 patients on MHD between June 2014 and October 2014 in the dialysis center of the Second Hospital of Tianjin Medical University were included prospectively.Lateral lumbar radiography were applied to evaluate patients' AAC score (AACs) at baseline and after two-years of follow-up respectively.According to the change of AACs,the patients were divided into rapid AAC progression group and non-rapid AAC progression group.Multivariable Logistic regression models were used to determine the risk factors for the progression of AAC in MHD patients.Results At baseline,the presence of AAC (AACs≥1) was 43.5％(74/170).The mean follow-up duration was 27.6(24.7,28.0) months.AACs were available in 111 patients,and the presence of AAC was 78.4％(87/111).During the follow up,36 patients developed new AAC;rapid AAC progression was seen in 54 patients,and non-rapid AAC progression was seen in 57 patients.Multivariate Logistic regression analysis demonstrated that hyperphosphatemia (OR=4.373,95％ CI 1.562-7.246,P=0.005) and high density lipoprotein (HDL) (OR=0.031,95％CI 0.003-0.338,P=0.004) were independent risk factors for AAC progression in MHD patients.Conclusions Hyperphosphatemia and low HDL may promote the progression of AAC.Well-controlled serum phosphate and lipid metabolism may slow the progression of vascular calcification,reducing cardiovascular morbidity and mortality.

Objective To develop an arm support used for bilateral puncture during trans-radial coronary intervention (TRI) and to explore its effects. Methods The arm support used for bilateral radial artery puncture was designed and developed. Totally 100 patients who received TRI in the Cardiac Catheterization Room of Peking Union Medical College Hospital between May and June 2017 were selected and equally divided into an observation group and a control group according to the random number table. Patients in the observation group were served with the new arm support to reveal the points for radial artery puncture, while patients in the control group used the conventional wooden arm support. The effect of puncture was compared between the patients in the two groups. Results The time used for preparation before radial artery puncture was (1.58±0.56) min and the time need for puncturing and placing sheathing canal in the radial artery was (3.51±0.44) min in the patients in the observation group, both shorter than those of the patients in the control group (t=9.511, 8.740; P<0.05). Totally 96% of the patients felt comfortable with the new arm support, and the operation experience satisfaction in 80% of the doctors was excellent, both higher than those of the patients in the control group. Conclusions The performance of this new arm support for bilateral radial artery puncture is stable and reliable. Compared with conventional methods, the time used for preparation before radial artery puncture is shortened for nurses, and the time needed for puncturing and placing sheathing canal in the radial artery is shortened for doctors. The patients feel more comfortable when using this new arm support, and the doctors have a higher experience satisfaction. The new arm support is convenient and flexible for use, and may be used and promoted in cardiac catheterization rooms.

Objective To explore the effects of dietary intervention before selective coronary intervention on patients with type 2 diabetes mellitus and to provide reference and basis for building a feasible and practical preoperative dietary management system. Methods Totally 300 patients with type 2 diabetes mellitus who received coronary intervention in the Cardiac Catheterization Room of Peking Union Medical College Hospital from December 2016 to December 2017 were selected by convenient sampling and divided into the control group (n=150) and the observation group (n=150) according to the random number table. Patients in the control group were fasted for solids and liquids for 4 hours before coronary intervention, while patients in the observation group received foods and drinks for diabetic patients rather than being fasted for solids and liquids as well as individualized dietary guidance from dieticians, specialized diabetes nurses and intervention nurses jointly. The incidence rate of perioperative hypoglycemia. hunger, thirst, anxiety score before and after the intervention, comfort of dietary management were evaluated between the two groups. Results The control group scored higher in hunger, thirst and anxiety than the observation group (P＜0.05);the comfort of dietary management was higher in the observation group than in the control group (P＜ 0.05);the incidence rate of perioperative asymptomatic hypoglycemia in the observation group was 2.0%, while that in the control group was 20.6%;the incidence rate of perioperative symptomatic hypoglycemia in the observation group was 0, while that in the control group was 1.3%. Conclusions Patients with type 2 diabetes mellitus should not be fasted for solids and liquids as conventionally did before selective coronary intervention. Rather, a scientific preoperative dietary management model can prevent the incidence of perioperative hypoglycemia in patients with type 2 diabetes mellitus, enhancing the comfort and safety of operation during the perioperative period.

Objective To investigate the occurrence of left ventricular reverse remodeling (LVRR) and its predictive factors in patients with idiopathic or secondary dilated cardiomyopathy (DCM). Methods A cross-sectional survey was conducted in a consecutive cohort of patients with DCM admitted in our department between January, 2012 and June, 2016. Based on dynamic echocardiographic findings, LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) by≥100％or an absolute value of LVEF≥45％with simultaneously an absolute decrease in end-diastolic diameter (LVEDD)≥10 mm or an absolute value of LVEDD ≤55 mm (in men) or ≤50 mm (in women). The patients with LVRR and those without LVRR were compared for clinical data at admission to identify the potential factors for predicting LVRR. Results A total of 462 patients, who were followed up for 24.13±15.60 months, were included in this survey. In patients with idiopathic DCM who had LVRR, LVEDD was reduced (P<0.01), LVEF was improved (P<0.01) and the mean exercise tolerance was increased significantly (P<0.01) compared with those in patients without LVRR. Multiple logistic regression analysis showed that a shorter course of heart failure (OR=0.913, P<0.01), a high systolic blood pressure (OR=1.062, P<0.01), absence of electrolyte imbalance (OR=0.347, P<0.01), a low red cell distribution width (OR=0.205, P<0.01), a smaller LVEDD (OR=0.799, P<0.01) and a greater LVEF (OR=1.142, P<0.01) were independent predictors of LVRR in the idiopathic patients. In patients with secondary DCM, LVEDD was reduced (P<0.01), LVEF was improved (P<0.01), and the mean exercise tolerance was increased significantly (P<0.01) compared with those in patients without LVRR. Multiple logistic regression analysis showed that a shorter course of heart failure (OR=0.954, P<0.01), a low red cell distribution width (OR=1.011, P<0.01), and implementation of etiological treatment (OR=1.073, P<0.01) were independent predictors of LVRR in patients with secondary DCM. Conclusion The exercise tolerance, cardiac structure and function can be reversed in some of the patients with idiopathic or secondary DCM by administration of standard therapy for heart failure and etiological treatment.

Objective To investigate the occurrence of left ventricular reverse remodeling (LVRR) and its predictive factors in patients with idiopathic or secondary dilated cardiomyopathy (DCM). Methods A cross-sectional survey was conducted in a consecutive cohort of patients with DCM admitted in our department between January, 2012 and June, 2016. Based on dynamic echocardiographic findings, LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) by≥100％or an absolute value of LVEF≥45％with simultaneously an absolute decrease in end-diastolic diameter (LVEDD)≥10 mm or an absolute value of LVEDD ≤55 mm (in men) or ≤50 mm (in women). The patients with LVRR and those without LVRR were compared for clinical data at admission to identify the potential factors for predicting LVRR. Results A total of 462 patients, who were followed up for 24.13±15.60 months, were included in this survey. In patients with idiopathic DCM who had LVRR, LVEDD was reduced (P<0.01), LVEF was improved (P<0.01) and the mean exercise tolerance was increased significantly (P<0.01) compared with those in patients without LVRR. Multiple logistic regression analysis showed that a shorter course of heart failure (OR=0.913, P<0.01), a high systolic blood pressure (OR=1.062, P<0.01), absence of electrolyte imbalance (OR=0.347, P<0.01), a low red cell distribution width (OR=0.205, P<0.01), a smaller LVEDD (OR=0.799, P<0.01) and a greater LVEF (OR=1.142, P<0.01) were independent predictors of LVRR in the idiopathic patients. In patients with secondary DCM, LVEDD was reduced (P<0.01), LVEF was improved (P<0.01), and the mean exercise tolerance was increased significantly (P<0.01) compared with those in patients without LVRR. Multiple logistic regression analysis showed that a shorter course of heart failure (OR=0.954, P<0.01), a low red cell distribution width (OR=1.011, P<0.01), and implementation of etiological treatment (OR=1.073, P<0.01) were independent predictors of LVRR in patients with secondary DCM. Conclusion The exercise tolerance, cardiac structure and function can be reversed in some of the patients with idiopathic or secondary DCM by administration of standard therapy for heart failure and etiological treatment.

BACKGROUND: A large number of experiments in vivo and in vitro have shown that mesenchymal stem cells may obviously inhibit the lymphocytes and other immunocytes.OBJECTIVE: To investigate the effect of human umbilical cord mesenchymal stem cell transplantation on the immune function and prognosis of patients suffering decompensated liver cirrhosisn due to hepatitis B.METHODS: 118 patients with decompensated cirrhosis due to hepatitis B were randomly divided into control group (n=59) and observation group (n=59). The two groups all received normal medical treatment, and in addition, the observation group also received human umbilical cord mesenchymal stem cell transplantation. (4.0-4.5)×108 stem cells were transplanted twice by intervention via proper hepatic artery (10 mL) and intravenous infusion (10 mL) within 1 week after admission. The levels of serum interleukin-6, tumor necrosis factor-α, interleukin-10, transforming growth factor-β and the percentage of lymphocyte subsets in the peripheral blood were determined in the two groups before and 1, 4 weeks after treatment. The model for end-stage liver disease (MELD) score and Child-Pugh score of 118 patients after treatment for 12 weeks were observed and recorded, and liver failure, complications and survival during follow-up period in the two groups were observed. RESULTS AND CONCLUSION: After treatment for 1 and 4 weeks, the levels of serum interleukin-6 and tumor necrosis factor-α in the observation group were significantly lower than those in the control group (P < 0.05 or P <0.001), but the levels of serum interleukin-10 and transforming growth factor-β in the observation group were significantly higher than those in the control group (P < 0.05 or P < 0.001). After treatment for 1 week, the percentagesof CD3+CD4+T cell and CD4+CD25+Treg cells in the observation group were significantly higher than those in the control group (P < 0.001), but the percentages of CD3+CD8+ T cells and CD3-CD19+ B cells were significantly lower than those in the control group (P < 0.05 or P < 0.001). After treatment for 4 weeks, the percentages of CD3+ T cell ,CD3+CD4+ T cells and CD4+CD25+ Treg cells in the observation group were significantly higher than those in the control group (P < 0.05 or P < 0.001), but the percentages of CD3+CD8+ T cell and CD3-CD19+ B cells were significantly lower than those in the control group (P < 0.05 or P < 0.001). After treatment for 12 weeks, the MELD and Child-Pugh scores in the observation group were significantly lower than those in the control group (P < 0.05).During the follow-up period, none of the cases in the observation group developed liver failure, but five cases in the control group did. In addition, the incidence of complications and cumulative mortality in the observation group were significantly lower than those in the control group (P < 0.05). These results show that the human umbilical cord mesenchymal stem cell transplantation may alleviate liver inflammation and improve liver function, and then may reduce the incidence of hepatic failure and mortality for patients with decompensated cirrhosis due to hepatitis B.

Objective To study the relationships between patients'personality traits,coping styles, perceived social support and the doctor?patient relationship,try to build the relationship model of patients’ psychological factors and the doctor?patient relationship,and to understand the patients psychological factors influence on the doctor?patient relationship,to provide a basis for improving the doctor?patient relationship. Methods The doctor patient relationship evaluation questionnaire, Eysenck personality questionnaire re?vised,short scale for Chinese( EPQ?RSC) ,simplified coping style questionnaire( SCSQ) and perceived social support scale( PSSS) were used to survey 400 outpatients,using SPSS 22.0 and AMOS 17.0 for data analysis. Results There was statistically significant difference in psychoticism between the high and low doctor?pa?tient relationship evaluation score groups( t=-4.537, P<0.01).There was statistically significant difference in positive coping,family support,friend support,other support and perceived social support between the high and low score groups(P<0.05).Psychoticism had a direct positive effect on doctor?patient relationship( r=0.228, P=0.000) ,and perceived social support had a direct negative effect on the doctor?patient relationship ( r=-0.256, P=0.000).Psychoticism,neuroticism,positive coping and negative coping styles could affect the doctor?patient relationship indirectly by perceived social support. Conclusion Patient personality can affect the doctor?patient relationship directly,meanwhile,it can affect the doctor?patient relationship indirectly by perceived social support,and coping styles can only affect the doctor?patient relationship indirectly by per?ceived social support.

Objective To explore the optimum chest compression frequency and influencing factors of compression quality so as to provide reference and guidance for guaranteeing the high quality of CPR and related training.Methods A total of 1 75 new nurses attended a training on theory and skills of CPR for 3 days.And then,they were divided into 5 groups (1 control group +4 experimental groups)by random number method. Nurses in control group performed chest compression for 2 minutes without guidance for the frequency.In contrast,nurses in 4 experimental groups performed chest compression with the frequency of 1 00,1 1 0,1 20, 1 40 beats per minute (BPM)for 2 minutes guided by metronome.Results Compression quality indicators of 3 experimental groups (1 00,1 1 0,1 20 BPM)were better than that of control and 1 experimental groups (1 40 BPM).Compression frequency and weight of chest compression providers could collectively explain 1 3%, 1 0%,1 1 %,1 1 % of the variation in average compression depth,percentage of compression with sufficient depth,the ratio of time on compression and recoil,time to fatigue.Conclusions The optimum frequency is 1 00 -1 20 BPM.Compression frequency and weight of chest compression provider are influencing factors of compression quality.