This paper presents a rare renal biopsy-confirmed case of enoxaparin-induced anticoagulant-related nephropathy (ARN). A 62-year-old male was admitted with microscopic hematuria, massive albuminuria, and elevated serum creatinine following postoperative right shoulder joint infection. The serum creatinine level decreased after surgical debridement and antibiotic therapy. Enoxaparin (4 000 U daily) was initiated for thromboembolism prevention. The patient developed acute kidney injury with serum creatinine 517 μmol/L accompanied by gross hematuria. Renal biopsy revealed characteristic features of ARN coexisting with infection-related glomerulonephritis. After antibiotic therapy, urinary alkalinization, hemodialysis, and glucocorticoids (prednisone acetate 30 mg daily) of therapeutic interventions, the renal function partially recovered with dialysis discontinuation. The paper reviews the relevant literature on the risk factors, clinical manifestations, pathological features, diagnosis and treatment of ARN to improve clinicians' understanding.

Objective:To investigate the essential determinants that are critical to initiating the assembly of outer membrane proteins by replacing the POTRA domains of the translocator protein FhaC and the insertase protein TtOmp85 of the Omp85 family. Methods:FhaC, TtOmp85 proteins and their recombinant chimeric proteins after replacing the POTRA domain were obtained by overexpression and purification in vitro. An in vitro reconstitution system was used to investigate the effects of the different domains on the transport efficiency of the substrate outer membrane protein FhaB and the membrane insertion efficiency of OmpA. Results:Replacing the POTRA domain of FhaC with that of TtOmp85 led to the loss of the transport function of FhaB. During the membrane insertion process of OmpA, the FhaC mutant containing the POTRA of TtOmp85 protein acquired the ability to assemble OmpA. Conclusion:The compositional differences in the POTRA domain of Omp85 family proteins determine their abilities to recognize their substrate proteins.

Objective:To investigate the essential determinants that are critical to initiating the assembly of outer membrane proteins by replacing the POTRA domains of the translocator protein FhaC and the insertase protein TtOmp85 of the Omp85 family. Methods:FhaC, TtOmp85 proteins and their recombinant chimeric proteins after replacing the POTRA domain were obtained by overexpression and purification in vitro. An in vitro reconstitution system was used to investigate the effects of the different domains on the transport efficiency of the substrate outer membrane protein FhaB and the membrane insertion efficiency of OmpA. Results:Replacing the POTRA domain of FhaC with that of TtOmp85 led to the loss of the transport function of FhaB. During the membrane insertion process of OmpA, the FhaC mutant containing the POTRA of TtOmp85 protein acquired the ability to assemble OmpA. Conclusion:The compositional differences in the POTRA domain of Omp85 family proteins determine their abilities to recognize their substrate proteins.

This paper presents a rare renal biopsy-confirmed case of enoxaparin-induced anticoagulant-related nephropathy (ARN). A 62-year-old male was admitted with microscopic hematuria, massive albuminuria, and elevated serum creatinine following postoperative right shoulder joint infection. The serum creatinine level decreased after surgical debridement and antibiotic therapy. Enoxaparin (4 000 U daily) was initiated for thromboembolism prevention. The patient developed acute kidney injury with serum creatinine 517 μmol/L accompanied by gross hematuria. Renal biopsy revealed characteristic features of ARN coexisting with infection-related glomerulonephritis. After antibiotic therapy, urinary alkalinization, hemodialysis, and glucocorticoids (prednisone acetate 30 mg daily) of therapeutic interventions, the renal function partially recovered with dialysis discontinuation. The paper reviews the relevant literature on the risk factors, clinical manifestations, pathological features, diagnosis and treatment of ARN to improve clinicians' understanding.

Objective:To screen active antibacterial components from licorice extract using BamA and BamD, the core components of Escherichia coli ( E. coli) β-barrel assembly machinery (BAM), as targets in order to combat the increasingly serious problem of antibiotic resistance. Methods:Affinity ultrafiltration combined with high performance liquid chromatography-mass spectrometry (HPLC-MS) was used to screen the potential components interacting with BamA and BamD from licorice extract. Changes in the expression of bamA and bamD genes of E. coli after treatment with the compounds were detected by fluorescence quantitative PCR, and the effects of the compounds on the function of the BAM complex to integrate outer membrane proteins into the bacterial outer membrane were analyzed using an in vitro recombination system. The influence of the compounds on the integrity of bacterial membranes was evaluated through analyzing the accumulation of SDS within the bacterial cells. Results:Bioaffinity ultrafiltration combined with HPLC-MS screening revealed that 18β-glycyrrhetinic acid could interact with BamD. After 18β-glycyrrhetinic acid treatment, the expression of bamA gene increased by 1.5 times, and the expression of bamD gene increased by 2 times. However, the inhibitory effect of 18β-glycyrrhetinic acid on the membrane insertion function of the BAM complex was not observed in the in vitro recombinant system assay, and the cell membrane integrity assay experiments did not reveal any disruption of the E. coli cell membrane by 18β-glycyrrhetinic acid. Conclusions:Using BamA and BamD proteins as targets, a natural product screening method using affinity ultrafiltration combined with HPLC-MS is established. The screening result shows that 18β-glycyrrhetinic acid can interact with BamD and affect the expression of outer membrane proteins in E. coli. Therefore, the screening and experimental procedures established in this study are of good reference value for the screening of novel antimicrobial drugs from other sources targeting outer membrane proteins, and this study also suggests that the selection of the relevant target sites is crucial for the successful screening of the corresponding natural products.

Objective:To explore the changing trends and influencing factors of AIDS-related and non-AIDS-related deaths after receiving antiretroviral therapy (ART) among HIV-positive individuals in Dehong Dai Jingpo autonomous prefecture (Dehong) from 2010 to 2019.Methods:Based on the Chinese National treatment database, HIV patients who initiated ART from 2010 to 2019 were included in the analysis. The cumulative incidence function was used to estimate the cumulative incidence of AIDS-related death and non-AIDS-related death, respectively. The Fine-Grey model was used to compare the differences between AIDS-related and non-AIDS-related deaths and analyze its influencing factors.Results:A total of 7 068 HIV-positive individuals were included, of which 388 were AIDS-related deaths and 570 were non-AIDS-related deaths. The cumulative mortality rate at years 1, 2, 3, 4, 5, 7 and 9 after receiving ART were 2.27%, 3.46%, 4.47%, 5.03%, 5.84%, 6.61%, 7.40% for AIDS-related deaths, and 1.63%, 3.11%, 4.68%, 6.02%, 7.42%, 10.49%, 12.75% for non-AIDS-related deaths, respectively. In the Fine-Grey model, older age at ART initiation, male, unmarried, injection drug use as the transmission route, lower baseline BMI, lower baseline CD4 + T cell counts, baseline FIB-4 score >3.25, and baseline anemia were risk factors for AIDS-related death. In contrast, age at ART initiation ≥45 years, male, Dai, and Jingpo minority ethnicities, unmarried, injection drug use as the transmission route, lower baseline BMI, baseline FIB-4 score >3.25, baseline eGFR <60 ml·min -1·1.73 m -2, and baseline anemia were risk factors for non-AIDS-related deaths. Conclusions:The cumulative mortality rate was low among HIV-positive individuals after receiving ART in Dehong during 2010-2019. The mortality of non-AIDS-related deaths was higher than that of AIDS-related deaths. There were also differences in the factors influencing AIDS-related and non-AIDS-related deaths and interventions should be intensified to target the influencing factors for non-AIDS-related deaths.

Objective:To investigate the incidence of anemia and risk factors in HIV/AIDS patients with access to antiretroviral therapy (ART) during 2004-2018 in Dehong Jingpo and Dai Autonomous Prefecture (Dehong).Methods:A retrospective cohort study was conducted in HIV/AIDS patients receiving ART in Dehong during 2004-2018 based on the data extracted from the National HIV/AIDS antiretroviral therapy database. Cox proportional risk model was used to analyze the factors associated with the incidences of anemia and moderate or severe anemia in the HIV/AIDS patients. And the piecewise linear mixed-effects model was used to depict the trajectory of hemoglobin changes over time after initiating ART according to baseline level.Results:A total of 8 044 HIV/AIDS patients were included, in whom 6 337 (78.8%) were without anemia at baseline survey and had a median follow up time of 4.43 ( P 25, P 75: 1.50, 6.71) years. The median follow up time for 1 291 new anemia cases and 293 new moderate or severe anemia cases was 0.16 ( P 25, P 75: 0.07, 1.99) years and 0.48 ( P 25, P 75:0.09, 2.97) years, respectively. The incidence rate of anemia and moderate or severe anemia was 4.40 per 100 person-years and 0.41 per 100 person-years respectively. In multivariable Cox regression analysis, older age, being female, being in Dai and Jingpo ethnic group, baseline BMI <18.5 kg/m 2, baseline CD4 +T lymphocyte cell counts (CD4) <200 cells/μl, and zidovudine (AZT) -based initial treatment regimen were factors significantly and positively associated with incidence of anemia after treatment. Factors as being female, being in Dai ethnic group, baseline BMI <18.5 kg/m 2, mild baseline anemia, and AZT-based initial treatment regimen were significantly and positively associated with incidence of moderate or severe anemia after treatment. Conclusion:The risk for anemia was higher in HIV/AIDS patients with specific characteristics, such as age ≥60 years , being female, being in Dai and Jingpo ethnic groups, lower BMI, CD4 <200 cells/μl, and treatment of AZT, after initiation of ART in Dehong during 2004-2018. Additional efforts are needed to strengthen the screening, prevention and treatment of anemia in this population.

Objective: To study the prevalence and correlates of diabetes among HIV/AIDS who were on antiretroviral therapy (ART) in Dehong Dai and Jingpo autonomous prefectures (Dehong), Yunnan province. Methods: The database of HIV/AIDS receiving ART in Dehong was downloaded by using the basic information system of AIDS prevention and control in China. In this cross-sectional study, HIV/AIDS patients who were currently on ART and aged 18 years or above, were consecutively recruited, between July 2017 and June 2018, in Dehong. All the subjects underwent hemoglobin A1c (HbA1c) testing. Patient with diabetes was defined as meeting any of these indicators (HbA1c ≥6.5%, baseline FPG ≥7.0 mmol/L, FPG ≥7.0 mmol/L in the most recent visit). Both univariate and multivariate logistic regression analysis were carried on to evaluate the correlates of diabetes among the HIV/AIDS patients. Results: In total of 4 376 HIV/AIDS patients were included for analysis, with the average age as (43.7±10.1) years, proportion of males as 53.8% (2 356/4 376) and the HCV positive rate as 24.1% (1 055/4 376). The mean years was (8.9±3.8) years after the HIV diagnosis was made, and the mean duration on treatment was (6.8±2.9) years. The prevalence of diabetes was 11.4% (500/4 376). Through multivariate logistic regression analysis, data showed that the risk factors of diabetes of HIV/AIDS on ART were: aged 40 years or above, being male, HCV positive, baseline body mass index ≥24.0 kg/m², elevated TG ≥1.70 mmol/L in the most recent visit and baseline antiretroviral regimens under Efavirenz (EFV). Conclusions Prevalence rate of diabetes appeared higher in HIV/AIDS patients who were on ART in Dehong. Prevention and control measures should be targeted on HIV/AIDS patients who were with risk factors of diabetes as being elderly, male, HCV positive, overweight and higher TG. Further esearch is needed to evaluate the association between the use of EFV and diabetes.

Purpose To explore the clinical value of iodine content and energy spectrum in dual-source dual-energy CT scan in the diagnosis of inflammatory bowel disease reactive hyperplasia lymph nodes (LNs) and metastatic LNs in patients with colorectal cancer.Materials and Methods Complete dual energy scanning data of 51 reactive LNs in 30 patients with inflammatory bowel disease (15 cases of ulcerative colitis,15 cases of Crohn's disease) and 35 metastatic LNs in 20 patients with colorectal cancer confirmed by colonoscopy or pathology were collected and retrospectively analyzed.The iodine contents of reactive hyperplasia LNs and metastatic LNs were detected and the slopes of energy spectrum curves were compared between the two different pathological LNs.Moreover,the receiver operating characteristic curve was applied to determine the optimum sensitivity and specificity of differential diagnosis of these two kinds of LNs.Results The iodine contents of inflammatory bowel disease reactive hyperplasia LNs and metastatic LNs in patients with colorectal cancer in arterial phase were (2.66±0.70) mg/ml and (1.65± 0.81) mg/ml,and the slopes of curves were 2.81 ±0.56 and 0.14±0.09,respectively.There were significant differences in the iodine contents and the slopes of the energy spectral curves between these two kinds of LNs in arterial phase (P＜0.05).Moreover,the diagnostic efficacy of energy spectrum curve slope,of which the sensitivity,specificity and area under the curve was 96.7％,76.7％ and 0.846,respectively;was higher than those of iodine content in diagnosing inflammatory bowel disease reactive hyperplasia LNs and metastatic LNs.Conclusion Dual-source dual-energy CT-derived arterial phase measurement of iodine content and slope of energy spectral curve has certain significance for differential diagnosis of inflammatory bowel disease reactive hyperplasia LNs and metastatic LNs,and the slope of spectral curve is superior to iodine.

Purpose To explore the feasibility of dual source CT virtual unenhanced replacing conventional plain scan in parotid gland mass examination.Materials and Methods Thirty-five parotid gland mass (38 focus) confirmed through dual source CT and surgical operative pathology in the First Affiliated Hospital of Kunming Medical University were retrospectively analyzed,including 13 pleomorphic adenoma parotid,14 adenolymphoma (17 focus),5 malignant tumor and 3 inflammatory lesions.All patients received conventional plain scan and dual energy enhanced scan.Liver virtual unenhanced software was adopted to obtain virtual unenhanced image in arterial phase and concordance of parotid gland mass displayed on conventional plain scan and virtual unenhanced images was compared.Normal parotid tissue,focal area,salivary gland,thoracic paraspinal muscle,average CT value of lower jawbone,signal noise ratio noise ratio (SNR),contrast noise ratio noise ratio (CNR),image quality score,radiation dose and effective dose (ED) for conventional plain and virtual unenhanced were compared.Results Subjective image quality score for conventional plain scan and virtual unenhanced was 4.34 ± 0.80 and 4.17 ± 0.82,respectively;and difference between the two was of no statistical significance (P＞0.05).Average CT value difference of angulus mandibulae thoracic paraspinal muscle,submandibular gland and normal parotid for 35 patients with parotid space-occupying lesions with conventional plain scan and virtual plain scan was of no statistical difference (P＞0.05).The average CT value of conventional plain scan parotid mass and mandible compared with the virtual plain scan,the difference was statistically significant (P＜0.05).SNR difference for parotid gland mass was of statistical significance (P＜0.05).Difference of CNR between the two groups was of no statistical significance (P＞0.05).ED of virtual plain scan was lower than that of conventional plain scan and the difference was of statistical significance (P＜0.05).The reduced radiation dose was about 38.6％.Conclusion Conventional plain scan and virtual unenhanced are of highly concordance in examination and diagnosis of parotid gland mass and radiation dose for virtual unenhanced is less.