Objective:To investigate the clinicopathological features and the prognosis of IgA nephropathy (IgAN) in children with massive proteinuria.Methods:It was a retrospective cohort study. Clinical data of IgAN children with massive proteinuria admitted to the Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2008 to December 2021 were retrospectively analyzed. Patients were divided into effective group and ineffective group according to whether urine protein turned negative after 6 months of initial treatment. The follow-up endpoint event was defined as a reduction in proteinuria of less than 50% or end-stage renal disease (ESRD) achievement. MedCalc software was used to perform Kaplan-Meier survival analysis, and Log-rank test was used to compare the difference of renal survival between the two groups.Results:A total of 127 patients were diagnosed as primary IgAN by renal biopsy, of whom 57 patients with IgAN showed massive proteinuria. These 57 IgAN patients with macroproteinuria accounted for 44.9% of the total IgAN patients and were enrolled in the study. Among the 57 cases, 33 cases (57.9%) were Lee's grade Ⅲ, 11 cases (19.3%) were below Lee's grade Ⅲ, and 13 cases (22.8%) were above Lee's grade Ⅲ. The follow-up time was 4.0 (3.0,5.8) years. In the initial treatment, among 57 patients, 46 (80.7%) were effective (effective group) and 11 (19.3%) were ineffective (ineffective group). Compared with the effective group, the ineffective group had a higher proportion of concurrent AKI at the onset of disease and longer recovery time of renal function, with significant difference (7/11 vs. 13/46, χ2=4.878, P=0.027). Compared with the effective group, the proportion of Lee grade Ⅲ or above was higher in the ineffective group, and the difference was statistically significant (5/11 vs. 8/46, χ2=3.971, P=0.046). There were significant differences in endocapillary hypercellularity (E1), segmental glomerulosclerosis or adhesion (S1) and cellular/fibrocellular crescents (C2) of Oxford classification between IgAN children with Lee grade Ⅲ or below and those over Lee grade Ⅲ (11/13 vs. 20/44, χ2=6.204, P=0.013; 12/13 vs. 17/44, χ2=11.566, P=0.001; 9/13 vs. 7/44, χ2=14.131, P=0.001). Among 57 patients, endpoint events occurred in 2 patients who both were urinary protein unmitigated, and none of the children progressed to ESRD. There was no significant difference in cumulative renal survival between the two groups by Kaplan-Meier survival analysis and Log-rank test ( χ2=0.537, P=0.460) after addition of calcineurin inhibitors (CNIs) to the initial treatment ineffective group. Conclusions:Macroproteinuria is the prominent manifestation of IgAN in children. The pathological type is mainly Lee grade Ⅲ. Children with macroproteinuria have a good prognosis in the short and medium term after active treatment. For IgAN with macroproteinuria that does not respond well to initial treatment, AKI is more common at onset, and renal function recovery time is longer. The application of CNIs may have a certain effect on improving the renal outcome of IgAN with massive proteinuria.

Objective To observe the value of ultrasound vector flow imaging(VFI)combined with singular value decomposition(SVD)filtering for depicting deep microvasculature flow velocity of liver.Methods Grayscale ultrasound,CDFI and contrast-enhanced ultrasound(CEUS)were prospectively performed in a patient with suspected liver hemangioma.Images of CEUS were dealt with SVD filtering.Cross-correlation algorithm was used to obtain images of VFI based on grayscale ultrasound,original CEUS and SVD filtered CEUS,respectively,and the ability of the above images for depicting liver microvascular flow direction and velocity were compared.Results The signal-to-noise ratio(SNR)of liver grayscale ultrasound,original CEUS and SVD filtered CEUS images was 7.56,17.65 and 22.43 dB,respectively,while their contrast-to-issue ratio(CTR)was 1.12,7.56 and 16.34 dB,respectively.Compared with VFI based on grayscale ultrasound and original CEUS,VFI based on SVD filtered CEUS could display faster velocity and more uniform direction of blood flow.Before and after SVD filtering,liver microvascular flow velocity measured with VFI was 1.91(0.81,4.11)and 6.83(4.25,9.41)mm/s,respectively,which were significantly different(Z=-10.671,P＜0.001).Conclusion Combined with SVD filtering could significantly improve the efficiency of VFI for depicting liver deep microvasculature flow velocity.

Objective To construct and validate a risk prediction model for delayed healing of venous leg ulcer(VLU),so as to provide a reference basis for early identification of people at high risk of delayed healing.Methods Using a convenience sampling method,331 VLU patients attending vascular surgery departments in 2 tertiary A hospitals in Sichuan Province from January 2018 to December 2022 were selected as a modeling group and an internal validation group,and 112 patients admitted to another tertiary A hospital were selected as an external validation group.Risk factors for delayed healing in VLU patients were screened using univariate analysis,LASSO regression,and multivariate logistic regression analysis,and a risk prediction model was constructed using R software,and the predictive effects of the models were examined using the area under the receiver operating characteristic curve,the Hosmer-Lemeshow test,decision curve,and the bootstrap resampling for internal validation and spatial external validation were performed,respectively.Results The predictors that ultimately entered the prediction model were diabetes(OR=4.752),deep vein thrombosis(OR=4.104),lipodermatosclerosis(OR=5.405),ulcer recurrence(OR=3.239),and ankle mobility(OR=5.520).The model had good discrimination(AUC:0.819 for internal validation and 0.858 for external validation),calibration(Hosmer-Lemeshow test:χ2=13.517,P=0.095 for internal validation and χ2=3.375,P=0.909 for external validation)and clinical validity.Conclusion The model constructed in this study has good differentiation and calibration,and it can effectively predict people at high risk of delayed healing of VLU,which facilitates targeted clinical interventions to improve ulcer outcomes and reduce the risk of delayed ulcer healing.

Objective To compare the application of multifunctional ureterostomy stent and traditional ureterostomy internal stent in patients with total ureterostomy.Methods Prospectively,102 patients with bladder cancer and undergoing elective radical cystectomy with urinary diversion admitted to our hospital from March 2019 to March 2023 were selected for the study.According to the random number rank method,the patients were divided into the study group(51 cases)and the control group(51 cases).The control group was given a traditional single-J ureteral stomy stent drainage device,and the research group was given a multifunctional ureteral stomy stent drainage device.The differences of OAI score,renal function index(eGFR),recent complications,long-term complications and quality of life(FACT-BL score)were compared between the two groups.Results OAI scores 1 month,3 months and 6 months after surgery(study group:49.33±4.07,57.29±3.90,68.25±3.76;control group:44.25±4.61,52.31±4.58,59.06±4.37)and before surgery(study group:32.71±4.32;control group:33.18±4.74)compared with higher levels(P＜0.05),but the study group was higher than the control group(P＜0.05).Repeated measurement ANOVA results showed that eGFR at 3 months and 6 months after surgery(study group:86.07±4.07,88.01±3.01;control group:83.09±3.06,85.06±5.09)and before surgery(study group:82.05±6.04;control group:81.03±5.06)compared with higher levels(P＜0.05),but the study group was higher than the control group(P＜0.05).The total rate of recent complications in the study group was lower than that in the control group(7.84％VS 23.53％,P＜0.05).The total incidence of long-term complications in the study group was lower than that in the control group(43.14％VS 78.43％,P＜0.05).Emotional status score,physical status score,functional status score,social and family status score,BSS score,FACT-BL total score of the two groups 6 months after surgery(study group:20.25±2.36,24.92±1.87,25.65±1.11,26.02±1.14,32.75±1.76,129.59±5.74;Control group:18.65±3.10,20.18±3.02,23.51±1.29,21.51±2.24,30.26±3.07,114.10±10.37)and preoperative(study group:14.27±3.56,16.57±3.58,17.27±2.35,17.49±2.64,23.41±5.25,89.02±13.62;Control group:14.39±3.44,16.47±3.25,17.22±2.34,17.55±2.59,23.43±5.25,89.25±13.62)were increased(P＜0.05),and the study group was higher than the control group(P＜0.05).Conclusion The application of multifunctional ureteral stent in patients with ureteral cutaneous stomy with total cystotomy can effectively improve the adaptability of stomy,promote the recovery of renal function,reduce the risk of short-term and long-term complications,and improve the quality of life of patients.

Objective:To explore the application value of singular value decomposition(SVD)in optimizing the image quality of contrast-enhanced ultrasound(CEUS)and perioperative CEUS assessment of microwave ablation(MWA)for thyroid nodule.Methods:The data sets of two-dimensional ultrasound and CEUS images of two patients with thyroid nodules,who underwent MWA in China Resources&Wisco General Hospital affiliated to Wuhan University of Science and Technology from April 2023,were collected.The contrast images based on CEUS images after SVD filtering were obtained according to the normalized cross-correlation algorithm,and the differences of signal-to-noise ratio(SNR)and micro-vessel density(MVD)between the contrast images after SVD filtering and original CEUS images were compared.Results:Compared with the original CEUS images of thyroid nodules before and after MWA,the contrast images that were processed by SVD filtering can more clearly show the vascular structure with thyroid nodules,and can detect more signals of blood flow.The results showed that the average SNR of the original CEUS images after operation was(1.07±0.66)dB,and the average SNR of the contrast images by SVD filtering after operation was(6.21±1.01)dB(t=-6.015,P=0.038).The average MVD of the original CEUS images after operation was(0.60±0.33)%,and the average MVD of the contrast images of SVD filtering after operation was(5.42±0.67)%(t=-9.076,P=0.029).It can show that the SNR and MVD of the contrast images of SVD-filtering after operation were significantly higher than these of the original CEUS images after operation,and the results of these studies were significant.Conclusion:SVD filtering can effectively suppress noise and enhance the signals of micro-blood flow.The improved quality of contrast images can be used in the accurate diagnosis of perioperative MWA of thyroid nodules,it can sensitively detect the residually incomplete areas of ablation after operation,so as to guide clinicians to carry out more thorough ablation treatment and provide decision support for the assessment of curative effect of accurate ablation.

Pulmonary fibrosis(PF)is an irreversible lung disease that is characterized by excessive scar tissue with a poor median survival rate of 2-3 years.The inhibition of transforming growth factor-β receptor type-Ⅰ(TGF-β RI)by an appropriate drug may provide a promising strategy for the treatment of this disease.Polygonum cuspidatum(PC)is a well-known traditional Chinese herbal medicine which has an anti-PF effect.Accordingly,a combination of high resolution mass spectrometry with an in silico strategy was developed as a new method to search for potential chemical ingredients of PC that target the TGF-β RI.Based on this strategy,a total of 24 ingredients were identified.Then,absorption,distribution,meta-bolism,and excretion(ADME)-related properties were subsequently predicted to exclude compounds with potentially undesirable pharmacokinetics behaviour.Molecular docking studies on TGF-β RI were adopted to discover new PF inhibitors.Eventually,a compound that exists in PC known as resveratrol was proven to have excellent biological activity on TGF-β RI,with an ICso of 2.211 μM in vitro.Furthermore,the complex formed through molecular docking was tested via molecular dynamics simulations,which revealed that resveratrol had strong interactions with residues of TGF-β RI.This study revealed that resveratrol has significant potential as a treatment for PF due to its ability to target TGF-β RI.In addition,this research demonstrated the exploration of natural products with excellent biological activities toward specific targets via high resolution mass spectrometry in combination with in silico technology is a promising strategy for the discovery of novel drugs.

Objective:To explore the application effect of a new evaluation system based on virtual simulation system in the evaluation of functional science experiment teaching.Methods:The data of students' learning in the 2019-2020 academic year were collected, and the impact of using virtual simulation teaching system on the achievement of teaching goals under the new teaching evaluation standard was comparatively analyzed. Questionnaire survey was conducted to study students' evaluation on the virtual simulation teaching system. SPSS 22.0 was used for chi-square test.Results:The students who used the new formative evaluation standard had a virtual academic excellence rate of 75.49% (308/408), while the unused students had an excellence rate of only 32.22% (135/419), with significant differences ( P<0.01). The number of virtual simulation items required for different teaching objectives were 4, 11 and 14, respectively, and the corresponding students' virtual simulation system outstanding rate was 99.19% (246/248), 93.14% (380/408), 84.72% (488/576), with significant differences ( P<0.01). And 93.8% (348/371) students thought the learning of the virtual simulation system could help improve the success rate of the experiment, and 93.26% (346/371) of the students believed that it had improved the ability to analyze and deal with unexpected problems in the experimental class. Conclusion:The new evaluation system based on the virtual simulation system can promote the improvement of the experimental teaching quality of functional science.

Objective:To investigate the application value of establishing the differential diagnosis model of pulmonary tuberculosis using routine laboratory data.Methods:The retrospective study was conducted. The routine laboratory data of newly diagnosed patients with pulmonary tuberculosis and other pulmonary diseases in Beijng Jishuitan Hospital and Beijing Hepingli Hospital from May 2015 to November 2021were collected. According to the random numbers showed in the computer, all the 11516 patients were divided into training dataset and test dataset with a ratio of 9∶1. Four machine learning algorithms, Support Vector Machine, Random Forest, K-Nearest Neighbor and Logistic Regression, were used to build models and select features. The diagnostic accuracy of each model was verified by using the 10-fold cross-validation method and the performance of each model was evaluated by using the receptor operator of characteristic (ROC) curve.Results:Random Forest was selected as the optimal machine learning algorithm to build the best feature model in the study. According to importance scale of factors, the differential diagnosis model of pulmonary tuberculosis consisting of 37 non-specific test indexes. In the validation set and test set the accuracy and area under curve (AUC) of the models were 0.747 and 0.736, the sensitivity, specificity and accuracy were 68.03% and 68.75%, 70.91% and 67.90%, 70.30% and 68.12%, respectively.Conclusion:A key tool in the differential diagnosis model of pulmonary tuberculosis was established by routine laboratory data in combination with machine learning. The results of this study need to be further verified by more data from medical institutions.

Objective:To establish and evaluate a new real-time quality control method that can identify the random errors by using the backpropagation neural network (BPNN) algorithm and taking blood glucose test as an example.Methods:A total of 219 000 blood glucose results measured by Siemens advia 2 400 analytical system from January 2019 to July 2020 and derived from Laboratory Information System of Beijing Chaoyang Hospital Laboratory Department was regarded as the unbiased data of our study. Six deviations with different sizes were introduced to generate the corresponding biased data. With each biased data, BPNN and MovSD algorithms were used and tested, and then evaluated by traceability method and clinical method.Results:For BPNN algorithm, the block size was pre-set to 10 and the false-positive rate in all biases was within 0.1%. For MovSD, however, the optimal block size and exclusive limit were 150 and 10% separately and its false-positive rate in all biases was 0.38%, which was 0.28% higher than BPNN. Especially, for the least two error factors of 0.5 and 1, all the random errors were not detected by MovSD; for the error factor larger than 1, random errors could be detected by MovSD but the MNPed was higher than that of BPNN under all deviations. The difference was up to 91.67 times. 460 000 reference data were produced by traceability procedure. The uncertainty of BPNN algorithm evaluated by these reference data was only 0.078%.Conclusion:A real-time quality control method based on BPNN algorithm was successfully established to identify random errors in analytical phase, which was more efficient than MovSD method and provided a new idea and method for the identification of random errors in clinical practice.

Objective:To investigate the expressions of lysine specific demethylase 1 (LSD1) and podoplanin (PDPN) in tongue squamous cell carcinoma and the correlation between LSD1 or PDPN and clinicopathological characteristics or prognosis.Methods:A total of 67 cases of tongue squamous cell carcinoma and corresponding paracancerous normal tissues in the First Affiliated Hospital of Xinjiang Medical University from January 2011 to January 2016 were selected. The expressions of LSD1 and PDPN in cancer and paracancerous tissues were detected by immunohistochemical method, and the patients were followed up for a long time to analyze the correlation between the expression of LSD1 or PDPN and clinicopathological characteristics or prognosis.Results:The expressions of LSD1 and PDPN in tongue squamous cell carcinoma tissues were higher than those in paracancerous tissues, and the differences were statistically significant ( Z=6.089, P<0.001; Z=5.781, P<0.001). The expression intensities of LSD1 and PDPN were significantly different in patients with different clinical stage ( χ2=11.487, P=0.001; χ2=8.111, P=0.004), lymph node metastasis ( χ2=4.772, P=0.029; χ2=6.206, P=0.013) and tumor size ( χ2=5.985, P=0.014; χ2=4.247, P=0.039). The expression intensity of LSD1 was also significantly different in patients with different degrees of differentiation ( χ2=6.660, P=0.010). In univariate analysis, LSD1 expression intensity was negatively correlated with progression-free survival (PFS) and overall survival (OS) ( χ2=18.930, P<0.001; χ2=16.257, P<0.001), PDPN expression intensity was negatively correlated with PFS and OS ( χ2=31.720, P<0.001; χ2=18.390, P<0.001), and tumor size was negatively correlated with PFS and OS ( χ2=5.326, P=0.021; χ2=8.843, P=0.003). Postoperative radiotherapy and clinical stage were positively and negatively correlated with OS respectively ( χ2=4.197, P=0.040; χ2=6.355, P=0.012). In multivariate analysis, LSD1 was an independent risk factor for PFS and OS ( HR=5.743, 95% CI: 1.012-32.579, P=0.048; HR=17.759, 95% CI: 2.303-136.916, P=0.006), PDPN was an independent risk factor for PFS ( HR=4.380, 95% CI: 1.258-15.254, P=0.020), postoperative radiotherapy was a protective factor for PFS and OS ( HR=0.374, 95% CI: 0.157-0.895, P=0.027; HR=0.218, 95% CI: 0.091-0.521, P=0.001), and clinical stage was an independent risk factor for OS ( HR=2.637, 95% CI: 1.107-6.280, P=0.029). In tongue squamous cell carcinoma tissues, the expression of LSD1 was positively correlated with that of PDPN ( rs=0.655, P<0.001). Conclusion:The expressions of LSD1 and PDPN in tongue squamous cell carcinoma are higher than those in adjacent tissues. LSD1 is an independent risk factor for PFS and OS, PDPN is an independent risk factor for PFS, clinical stage is an independent risk factor for OS, and postoperative radiotherapy is a protective factor for PFS and OS. There is a positive correlation between the expressions of LSD1 and PDPN in tongue squamous cell carcinoma, and they can both be used as independent predictors of prognosis in patients with tongue squamous cell carcinoma.