OBJECTIVE: To explore whether streptococcal infection may aggravate renal damage in children with Henoch-Schönlein purpura nephritis and its possible mechanism. METHODS: In the study, 485 children diagnosed with Henoch-Schönlein purpura nephritis from July 2015 to December 2019 were selected to analyze their clinical data retrospectively. According to the diagnosis of discharge, whether it was combined with streptococcal infection, the children were divided into two groups. The experimental group contained 91 children with Henoch-Schönlein purpura nephritis combined with streptococcal infection, and there were 394 children who were not infected with Streptococcus in the control group. Suitable test items were preliminarily selected through artificial neural network, and then data analysis was performed through SPSS 23.0. RESULTS: The children with Henoch-Schönlein purpura nephritis infected with streptococcus had statistically significant differences compared with the uninfected children in the test items of urine protein, liver and kidney function, immunoglobulin and complement. Anti-streptolysin O had mild correlation with IgG (Spearman r=-0.328), fibrin degradation products (Spearman r=-0.207), total protein (Spearman r=-0.202) and globulin (Spearman r=-0.223). Compared with the children who were not infected with streptococcus, the differences of the average levels of age (P=0.001), IgG (P < 0.001), fibrin degradation products (P=0.019), total protein (P < 0.001), globulin (P < 0.001), IgA (P < 0.001), IgM (P=0.003), complement 3 (P=0.016), complement 4 (P=0.002), albumin/globulin ratio (P=0.007), alkaline phosphatase (P=0.036), and estimated glomerular filtration rate (P=0.039) in the infected children were statistically significant. In order to explore the risk factors of kidney damage in the children with Henoch-Schönlein purpura nephritis, Logistic regression was performed using anti-streptolysin O, age, immunoglobulin and complement as independent variables, urine protein detection parameters, liver and kidney functions as dependent variables. Age ≤10 years old and hypocomplementemia might be risk factors for aggravating renal damage in the children with Henoch-Schönlein purpura nephritis. CONCLUSION Streptococcal infections may aggravate renal damage in children with Henoch-Schönlein purpura nephritis, in which hypocomplementemia, inflammation, fibrinolysis and disorders of coagulation perhaps play an important role. Children with streptococcal infection should be treated with anti-infective treatment in time and necessarily, and followed up after discharge regularly.
Humans ; IgA Vasculitis/complications* ; Streptococcal Infections/complications* ; Child ; Male ; Female ; Nephritis/microbiology* ; Retrospective Studies ; Child, Preschool ; Kidney/pathology* ; Adolescent

Objective To assess the predictive value of proprotein convertase subtilisin/kexin type-9(PCSK9)combined with lactic acid(Lac)and Sequential Organ Failure Assessment(SOFA)score in determining the 28-day mortality risk of patients with sepsis.Methods A total of 203 patients with sepsis were followed up for 28 days.Patients were divided into the death group(n=56)and the survival group(n=147)according to the clinical outcome.The general data and clinical indicators were compared between the two groups.The prediction model of 28 day mortality risk of sepsis patients was established by multivariate Logistic regression analysis,and the nomogram of the prediction model visualization was drawn.Results Alanine aminotransferase,serum creatinine,blood urea nitrogen,Lac,PCSK9 and SOFA score were higher in the death group than those in the survival group(P＜0.05),while the hemoglobin level was lower than that in the survival group(P＜0.05).The multivariable Logistic regression analysis identified that elevated levels of Lac(OR=1.197,95％CI:1.019-1.435),PCSK9(OR=1.002,95％CI:1.001-1.003)and SOFA score(OR=1.858,95％CI:1.528-2.340)were independent risk factors for 28-day mortality in patients with sepsis(P＜0.05).Nomogram was developed using these three indicators,and the linear predictor cutoff value was-1.06.Patients were divided into the low-risk group(n=126)and the high-risk group(n=77).The 28-day mortality rates were 4.0％for the low-risk group and 66.2％for the high-risk group.Internal validation showed that the model with these three indicators had good discrimination(C-index=0.924,95％CI:0.881～0.960,P＜0.05),calibration(x2=11.543,P＞0.05)and clinical utility.Conclusion The combination of serum PCSK9,Lac and SOFA scores at admission effectively predicts 28-day mortality risk in sepsis patients.

Objective To explore the magnetic resonance(MR)imaging characteristics of joint damage caused by Chikungunya virus(CHIKV)and its correlation with pain severity,and analyze the value of T2-Mapping in asse-ssing the severity and prognosis of such damage.Methods A multicenter retrospective study design was adopted,and patients with CHIKV infection accompanied by joint pain were included in analysis.Multi-joint MR scans were performed to assess joint effusion,synovial thickening,bone marrow edema,and cartilage damage.T2-Mapping values were measured.Pain severity was assessed using the Visual Analog Scale(VAS),and imaging findings were independently assessed by two radiologists.Results A total of 131 patients were included in the study.The inci-dence of joint cavity and/or synovial sac effusion was the highest(77.1％,n=101),with knee and ankle joint effu-sion accounting for 81.2％(severe,mild-moderate were 17 and 65 cases,respectively),other joint effusion were mild.78 cases had synovial thickening(14 and 64 were severe and mild-moderate cases,respectively),27 cases had tenosynovitis,21 cases had bone marrow edema(primarily in the knee and ankle joints).19 cases had cartilage damage,114 cases presented muscle soft tissue edema(17 and 97 were severe and mild-moderate cases,respective-ly),28 cases had Kager's fat pad edema.Patients with elevated T2-Mapping values exhibited more pronounced chronic joint pain,with T2-Mapping values in the cartilage damage site increasing by 40％-60％compared with normal cartilage site(19 cases in total).The T2-Mapping value for severely damaged soft tissue was(52.3+6.7)ms,while for mildly to moderately damaged soft tissue was(42.3±5.2)ms,both significantly higher than normal refe-rence values(＜35 ms,both P＜0.05).Among 17 patients with severe soft tissue damage,12 experienced persistent pain for over one month,with statistically significant differences in T2 values compared with those with mild-mode-rate damage(P＜0.05).This further suggested that the degree of elevation in T2-Mapping values was closely related to the duration of pain and the severity of damage.After one-month follow-up,103 patients had pain relief.Among the 28 patients with ongoing pain,17 developed into subacute bone joint pain.Bone marrow edema(81.0％),ele-vation of T2-Mapping value of cartilage(89.5％),and severe synovial thickening(71.4％)were high-risk MR manifestations of subacute bone joint pain.The incidences of subacute joint cavity/sac effusion and subacute tenosy-novitis were 3.0％and 7.4％,respectively.Conclusion MR can clearly display the inflammatory and structural changes in CHIKV joint damage,and T2-Mapping values may serve as a potential imaging measurement parameter for assessing severity and prognosis of damage.

Guided by Zhang Zhongjing's axiom that"blood stasis induces water",this study develops stage-specific treatment strategies for edema in Kidney Consumption Disorder by examining its four-stage pathogenic progression:Sluggish Flow → Stagnant Obstruction → Depressed Accumulation → Stasis Congelation.We propose an integrated approach that reinforces the root by warming the kidney and replenishing essence,while addressing the branch by activating blood circulation and promoting diuresis.Stage-specific interventions include:for the Sluggish Flow Phase,warming and tonifying kidney Yang combined with unblocking Yang to promote uri-nation;for the Stagnant Obstruction Phase,warming the kidney and replenishing essence supported by activating blood circulation and freeing the collateral channels;for the Depressed Accumulation Phase,quickening blood and resolving stasis,regulating Qi and trans-forming turbidity,along with warming the kidney and strengthening essence;and for the Stasis Congelation Phase,expelling stagnant accumulations while simultaneously regulating essence and blood.This framework advances novel pattern-determined strategies for Kid-ney Consumption edema management.

Objective To assess the predictive value of proprotein convertase subtilisin/kexin type-9(PCSK9)combined with lactic acid(Lac)and Sequential Organ Failure Assessment(SOFA)score in determining the 28-day mortality risk of patients with sepsis.Methods A total of 203 patients with sepsis were followed up for 28 days.Patients were divided into the death group(n=56)and the survival group(n=147)according to the clinical outcome.The general data and clinical indicators were compared between the two groups.The prediction model of 28 day mortality risk of sepsis patients was established by multivariate Logistic regression analysis,and the nomogram of the prediction model visualization was drawn.Results Alanine aminotransferase,serum creatinine,blood urea nitrogen,Lac,PCSK9 and SOFA score were higher in the death group than those in the survival group(P＜0.05),while the hemoglobin level was lower than that in the survival group(P＜0.05).The multivariable Logistic regression analysis identified that elevated levels of Lac(OR=1.197,95％CI:1.019-1.435),PCSK9(OR=1.002,95％CI:1.001-1.003)and SOFA score(OR=1.858,95％CI:1.528-2.340)were independent risk factors for 28-day mortality in patients with sepsis(P＜0.05).Nomogram was developed using these three indicators,and the linear predictor cutoff value was-1.06.Patients were divided into the low-risk group(n=126)and the high-risk group(n=77).The 28-day mortality rates were 4.0％for the low-risk group and 66.2％for the high-risk group.Internal validation showed that the model with these three indicators had good discrimination(C-index=0.924,95％CI:0.881～0.960,P＜0.05),calibration(x2=11.543,P＞0.05)and clinical utility.Conclusion The combination of serum PCSK9,Lac and SOFA scores at admission effectively predicts 28-day mortality risk in sepsis patients.

Guided by Zhang Zhongjing's axiom that"blood stasis induces water",this study develops stage-specific treatment strategies for edema in Kidney Consumption Disorder by examining its four-stage pathogenic progression:Sluggish Flow → Stagnant Obstruction → Depressed Accumulation → Stasis Congelation.We propose an integrated approach that reinforces the root by warming the kidney and replenishing essence,while addressing the branch by activating blood circulation and promoting diuresis.Stage-specific interventions include:for the Sluggish Flow Phase,warming and tonifying kidney Yang combined with unblocking Yang to promote uri-nation;for the Stagnant Obstruction Phase,warming the kidney and replenishing essence supported by activating blood circulation and freeing the collateral channels;for the Depressed Accumulation Phase,quickening blood and resolving stasis,regulating Qi and trans-forming turbidity,along with warming the kidney and strengthening essence;and for the Stasis Congelation Phase,expelling stagnant accumulations while simultaneously regulating essence and blood.This framework advances novel pattern-determined strategies for Kid-ney Consumption edema management.

Objective To explore the magnetic resonance(MR)imaging characteristics of joint damage caused by Chikungunya virus(CHIKV)and its correlation with pain severity,and analyze the value of T2-Mapping in asse-ssing the severity and prognosis of such damage.Methods A multicenter retrospective study design was adopted,and patients with CHIKV infection accompanied by joint pain were included in analysis.Multi-joint MR scans were performed to assess joint effusion,synovial thickening,bone marrow edema,and cartilage damage.T2-Mapping values were measured.Pain severity was assessed using the Visual Analog Scale(VAS),and imaging findings were independently assessed by two radiologists.Results A total of 131 patients were included in the study.The inci-dence of joint cavity and/or synovial sac effusion was the highest(77.1％,n=101),with knee and ankle joint effu-sion accounting for 81.2％(severe,mild-moderate were 17 and 65 cases,respectively),other joint effusion were mild.78 cases had synovial thickening(14 and 64 were severe and mild-moderate cases,respectively),27 cases had tenosynovitis,21 cases had bone marrow edema(primarily in the knee and ankle joints).19 cases had cartilage damage,114 cases presented muscle soft tissue edema(17 and 97 were severe and mild-moderate cases,respective-ly),28 cases had Kager's fat pad edema.Patients with elevated T2-Mapping values exhibited more pronounced chronic joint pain,with T2-Mapping values in the cartilage damage site increasing by 40％-60％compared with normal cartilage site(19 cases in total).The T2-Mapping value for severely damaged soft tissue was(52.3+6.7)ms,while for mildly to moderately damaged soft tissue was(42.3±5.2)ms,both significantly higher than normal refe-rence values(＜35 ms,both P＜0.05).Among 17 patients with severe soft tissue damage,12 experienced persistent pain for over one month,with statistically significant differences in T2 values compared with those with mild-mode-rate damage(P＜0.05).This further suggested that the degree of elevation in T2-Mapping values was closely related to the duration of pain and the severity of damage.After one-month follow-up,103 patients had pain relief.Among the 28 patients with ongoing pain,17 developed into subacute bone joint pain.Bone marrow edema(81.0％),ele-vation of T2-Mapping value of cartilage(89.5％),and severe synovial thickening(71.4％)were high-risk MR manifestations of subacute bone joint pain.The incidences of subacute joint cavity/sac effusion and subacute tenosy-novitis were 3.0％and 7.4％,respectively.Conclusion MR can clearly display the inflammatory and structural changes in CHIKV joint damage,and T2-Mapping values may serve as a potential imaging measurement parameter for assessing severity and prognosis of damage.

Objective To compare the general conditions， clinical characteristics， and polysomnographic features of patients before， around， and after menopause.Methods Participants were divided into premenopausal， perimenopausal， and postmenopausal groups by the age of 45 years and 55 years. General conditions， clinical characteristics， and polysomnographic indicators were compared across these groups.Results A total of 316 patients before， around， and after menopause were included in this study. There were no significant between-group differences in the body mass index， smoking and alcohol consumption rates， sleep latency， sleep duration， sleep efficiency， and the durations and proportions of deep and light sleep. The perimenopausal and postmenopausal groups showed significantly increased nocturnal awakenings and significantly decreased nocturnal oxygen saturation compared with the premenopausal group. The apnea-hypopnea index （AHI） differed significantly between the three groups， showing an increasing trend.Conclusion Changes in reproductive status do not alter objective sleep duration and efficiency， and subjective perception contributes more to sleep disturbances around menopause. Changes in nocturnal sleep continuity， the AHI， and nocturnal minimum oxygen saturation suggest complex neuro-molecular mechanisms underlying the effects of hormonal variations on sleep in women.
Perimenopause

Particle size and surface properties are crucial for lymphatic drainage (LN), dendritic cell (DC) uptake, DC maturation, and antigen cross-presentation induced by nanovaccine injection, which lead to an effective cell-mediated immune response. However, the manner in which the particle size and surface properties of vaccine carriers such as mesoporous silica nanoparticles (MSNs) affect this immune response is unknown. We prepared 50, 100, and 200 nm of MSNs that adsorbed ovalbumin antigen (OVA) while modifying β-glucan to enhance immunogenicity. The results revealed that these MSNs with different particle sizes were just as efficient in vitro, and MSNs with β-glucan modification demonstrated higher efficacy. However, the in vivo results indicated that MSNs with smaller particle sizes have stronger lymphatic targeting efficiency and a greater ability to promote the maturation of DCs. The results also indicate that β-glucan-modified MSN, with a particle size of ∼100 nm, has a great potential as a vaccine delivery vehicle and immune adjuvant and offers a novel approach for the delivery of multiple therapeutic agents that target other lymph-mediated diseases.

Particle size and surface properties are crucial for lymphatic drainage(LN),dendritic cell(DC)uptake,DC maturation,and antigen cross-presentation induced by nanovaccine injection,which lead to an effective cell-mediated immune response.However,the manner in which the particle size and surface properties of vaccine carriers such as mesoporous silica nanoparticles(MSNs)affect this immune response is un-known.We prepared 50,100,and 200 nm of MSNs that adsorbed ovalbumin antigen(OVA)while modifying β-glucan to enhance immunogenicity.The results revealed that these MSNs with different particle sizes were just as efficient in vitro,and MSNs with β-glucan modification demonstrated higher efficacy.However,the in vivo results indicated that MSNs with smaller particle sizes have stronger lymphatic targeting efficiency and a greater ability to promote the maturation of DCs.The results also indicate that β-glucan-modified MSN,with a particle size of-100 nm,has a great potential as a vaccine delivery vehicle and immune adjuvant and offers a novel approach for the delivery of multiple thera-peutic agents that target other lymph-mediated diseases.