Objective:To investigate the prognosis and risk factors of IgA vasculitis nephritis (IgAVN) in children.Methods:A retrospective cohort study was conducted. Clinical data were collected from 264 children who were pathologically diagnosed with IgAVN at Department of Pediatric Nephrology, Tongji Hospital, affiliated with Tongji Medical College, Huazhong University of Science and Technology, between January 2011 and December 2017. All patients had a follow-up period of more than 3 years. Clinical characteristics, renal pathology, 3-year and 5-year prognosis were analyzed. The patients were grouped based on gender, age of onset (≤6 years, >6-9 years, and >9 years), pathological classification (≤Ⅲ and>Ⅲ),whether the prognosis was complete remission at 3 and 5 years. Independent sample t-tests, ANOVA or chi-squared test were used for intergroup comparisons. Spearman correlation analysis was applied for ordinal data, and multivariate Logistic regression was used to analyze factors affecting the prognosis. Receiver operating characteristic (ROC) curve was utilized to evaluate the predictive value of these factors. Results:Of the 264 children with IgAVN, 153 were male and 111 were female, the age of onset was 8.3 (6.7, 10.3) years, 118 patients (45%) with onset age >6-9 years accounted for the highest proportion. All patients presented with skin purpura and renal involvement, primarily manifesting as hematuria and/or proteinuria. Microscopic hematuria was observed in 253 patients (95.8%), while 246 patients (93.2%) showed proteinuria. In 256 patients (97.0%), hematuria or proteinuria urinalysis was detected within 6 months of skin purpura onset, and 243 patients (92.0%) underwent renal biopsy within 6 months of renal involvement. The most common clinical subtype in 264 IgAVN children was hematuria and proteinuria (204 cases, 77.3%), with grade Ⅲ being the predominant pathological classification (181 cases, 68.6%). Among children ≤6 years old, the 3-year complete remission rate was higher in males than in females (83.9% (26/31) vs. 7/16, χ2=8.12, P=0.012). Factors independently associated with poor 5-year prognosis included time from hematuria or proteinuria urinalysis to renal biopsy >6 months, elevated serum cholesterol levels, and incomplete remission 3 years post-biopsy ( OR=5.41, 1.39, 6.02, 95% CI 1.40-20.86, 1.04-1.84, 2.61-13.88, all P<0.05). The serum cholesterol has a predictive value for 5-year prognosis ( P=0.020, AUC=0.62, 95% CI 0.52-0.71, Youden index=0.27, cutoff=4.37). Conclusions:For children with IgAVN aged≤6 years, the 3-year prognosis is better in males than in females. Time from hematuria or proteinuria urinalysis to renal biopsy >6 months, elevated serum cholesterol levels, and incomplete remission at 3 years post-biopsy may be independent risk factors for poor 5-year prognosis in children with IgAVN.

OBJECTIVE: To evaluate the correlation of magnetic resonance (MR) T₂-weighted image (T₂WI) signal characteristics of adenomyosis and the efficacy of high-intensity focused ultrasound (HIFU) ablation. METHODS: Based on the presence or absence of patchy hyperintense foci on preoperative MR T₂WI, the patients with adenomyosis undergoing HIFU treatment were divided into homogeneous signal group and heterogeneous signal group, and the heterogeneous group was further divided into heterogeneous hypointense group and heterogeneous isointense group according to signal intensity of the lesions. The patients in heterogeneous signal group were matched with the patients in the homogeneous group at a 1:1 ratio using the propensity score matching, and similarly, the patients in the heterogeneous hypointense group were matched with those in the heterogeneous isointense group at a 1:1 ratio. The non-perfused volume ratio (NPVR) and relief of dysmenorrhea were used to assess the therapeutic efficacy in the 4 groups. RESULTS: A total of 299 patients were enrolled, who had a median preoperative dysmenorrhea score of 7.0 (6.0, 8.0) and a median NPVR of 53.5% (35.4, 70.1)%. After propensity score matching, the NPVR in homogeneous signal group was significantly higher than that in heterogeneous signal group [(60.3 ± 21.8)% vs (44.6±21.6)%, P < 0.05]. At 3, 6 and 12 months after HIFU, dysmenorrhea relief rates were higher in homogeneous signal group than in heterogeneous signal group, and the difference was statistically significant at 12 months (91.1% vs 76.8%, P < 0.05). The NPVR of heterogeneous hypointense group was higher than that of heterogeneous isointense group [(54.0±22.0) % vs (47.3± 22.9) %, P < 0.05]. At 6 months after HIFU, dysmenorrhea relief rate was significantly higher in heterogeneous hypointense group than in heterogeneous isointense group (91.5% vs 80.9%, P < 0.05). CONCLUSION The signal characteristics of adenomyosis on T₂WI are closely related with the outcome of HIFU ablation, and its efficacy is better for homogeneous than for heterogeneous adenomyosis, and better for heterogeneous hypointense adenomyosis than for heterogeneous isointense adenomyosis.
Female ; Humans ; Adenomyosis/pathology* ; Dysmenorrhea ; Cohort Studies ; Propensity Score ; High-Intensity Focused Ultrasound Ablation/methods* ; Treatment Outcome

Objective To analyze the aminoglycoside ( AG ) antibiotics resistance rate of carbapenem-resistant Klebsiella pneumoniae ( CRKP ) and its molecular mechanisms.Methods One hundred and four strains of CRKP isolated from 4 hospitals in Zhejiang Province from January 2013 to June 2014 were collected, including 56 strains from Sir Run Run Shaw Hospital , Zhejiang University School of Medicine ( S hospital ), 22 from the First Affiliated Hospital, Zhejiang University School of Medicine ( Z hospital), 13 from Yiwu TCM Hospitals (Y Hospital) and 13 from Fuyang First People's Hospital (F Hospital).VITEK 2 Compact method and K-B disk method were used to detect the susceptibility of commonly used antibiotics including three kinds of AGs (kanamycin, gentamycin and amikacin ).PCR and sequencing techniques were used to screen the aminoglycoside resistance -related 16S rRNA methylation genes (rmtA, rmtB and armA) and the aminoglycoside modified enzyme resistance gene [aac(6′)Ⅰb].The relationship between drug resistance and carrier status of drug resistance genes was analyzed .Homologous analysis of rmtB-positive strains was performed using PFGE to examine the epidemic spread of strains in each hospital.Results All 104 CRKP strains were multi-drug resistant and had high resistance to cephalosporins, fluoroquinolones ( ciprofloxacin, levofloxacin ) and nitrofurantoin.The resistance rates to gentamicin, kanamycin and amikacin were 73.1%(76/104), 64.4%(67/104) and 56.7%(59/104), respectively.The carrying rates of aminoglycoside-resistance genes were: rmtB 56.7%( 59/104 ), aac (6′)Ⅰb 17.3%(18/104), armA 1.9%(2/104); while no rmtA was detected.Thirty-seven strains did not carry the screened genes.Amikacin-resistant strains were resistant to both kanamycin and gentamicin, and both were rmtB-positive strains.The PFGE classification results showed that 104 strains were divided into 11 clonal populations, and there were scattered non-population clones in each hospital. There were seven major clonal populations (Ⅰ-Ⅶ) carrying rmtB genes, of which typeⅠ, typeⅢand typeⅤwere prevalent in S hospital ; typeⅡ, typeⅥand TypeⅦwere popular in Z hospital ; the distribution of strains in Y hospital was scattered ; F hospital had one independent clone type Ⅳ(3 strains).Conclusion AGs still have certain sensitivity to CRKP strains.The main mechanism of strain resistance to AGs is the rmtB gene-mediated 16S rRNA methylase.

Objective To explore the relationship among social support, postpartum depression and quality of life of puerperal women. Methods A total of 348 puerperal women were investigated with Postnatal Social Support Questionnaire,Edinburgh Postnatal Depression Scale (EPDS) and WHO Quality of Life-BREF (WHOQOL-BREF). Results Pearson correlation analysis showed that there was a significant positive correlation between social support and the quality of life (r=0.483, P < 0.01), and a significant negative correlation to postpartum depression (r=-0.243, P < 0.01),and a significant negative correlation between postpartum depression and quality of life (r=-0.408, P<0.01). Intermediary effect of postpartum depression was tested. Conclusions A good social support system is benefit to improve depression scores for EPDS, and promote the life quality in puerperal women.

Objective To observe the clinical effect of sling exercise therapy(S-E-T)combined with drug treatment for cervical vertigo in elderly patients.Methods Forty-nine elderly patients with cervical vertigo admitted to our hospital between January 2011 and July 2014 were randomly divided into an observation group(n=27)and a control group(n=22).The observation group was given 80 mg Ginaton(Extract of Ginkgo Biloba Leaves Tablets)produced by German Dr.Willmar Schwabe GmbH & Co.KG three times a day,combined with S-E-T,including cervical stability and stretching training for 40min,focusing on the neck global muscle and local stabilize muscle rehabilitation,once every other day.The control group was provided with the same drug treatment.During the 6-month intervention,both groups were given health education by the same therapist.Both groups were assessed using the neck disability index(NDI),visual analogue scale(VAS)and evaluation scale for cervical vertigo(ESCV) before and after the intervention,as well as at the last follow-up visit.Before the treatment and at the last follow-up visit,the cervical X-ray examination and trigger point check were also conducted for both groups.Results All the forty-nine patients were followed up for 4.83 to 6.70 months,with an average of(6.01 ± 0.49)months.Significant improvement was observed in the average ESCV score for both groups after the treatment.Compared with before the treatment,there was significant improvement in the average NDI and VAS right after the treatment and at the last follow-up visit in the observation group,but only at the last follow-up visit in the control group.From the cervical X-ray,no significant differences were found in the vertebral osteophyte formation,facet joints and uncovertebral joint degeneration between the 2 groups(P＞0.05),while significant differences were observed in the number of the neck trigger points(P＜0.05).Conclusion The sling exercise therapy combined with drug treatment can significantly improve cervical function,relieve pain and vertigo symptoms in elderly patients with cervical vertigo.The effect is better than drug treatment alone.

Objective To investigate the clinical effects of phacoemulsification combined with goniosynechialysis on the treatment of primary angle-closure glaucoma (PACG) with cataract. Methods The retrospective review included 71 patients (98 eyes) with PACG and cataract treated in Tianjin Huanghe Hospital. Patients were underwent phacoemulsification and intraocular lens implantation combined goniosynechialysis. Among these patients, there were 21 males (30 eyes) and 50 females (68 eyes). Patients ranged in age from 53 to 94 years old, everage (73.94 ± 6.43) years old. They were divided into acute angle-closure glaucoma with cataract group (47 patients, 64 eyes) and chronic angle-closure glaucoma with cataract group (24 patients, 34 eyes). The visual acuity, intraocular pressure (IOP), anterior chamber angle, anterior chamber depth (CCT), topical and oral medications and surgical complications were observed before and after surgery in two groups. All the patients were followed up for 6 months. Results At the end of follow-up, postoperative visual acuity, IOP, CCT, anterior chamber angle and IOP-lowing medicine (topical and oral medications) were all improved in the two groups compared with those of preoperative levels (all P < 0.01). There were no statistical differences in preoperative or postoperative average visual acuity, IOP and anterior chamber angle between two groups (all P > 0.05). Values of CCT were significantly higher before and after operation in chronic angle-closure glaucoma with cataract group than those of acute angle-closure glaucoma with cataract group (P < 0.05). No drug-control rate of intraocular pressure was 76.5% (26/34) for chronic angle-closure glaucoma with cataract group than that of acute angle-closure glaucoma with cataract group (100%, 64/64). There was no need on topical medication in acute angle-closure glaucoma with cataract group. There were 14 eyes had corneal edema and 8 eyes appeared iris fibrous exudation in two groups, while no other serious complications. Conclusion For patients with PACG and cataract, the combined surgery of phacoemulsification and goniosynechialysis is a safe and effective therapy that can improve visual acuity and reduce IOP with fewer complications.

Objective To investigate the mechanism of carbapenem-resistant in Enterobacteriaceae strains isolated from Fuyang First People′s Hospital and to analyze their epidemiological features. Methods The Enterobacteriaceae strains with reduced ertapenem susceptibility were isolated from the Fuy-ang First People′s Hospital during January 2013 to August 2014.K-B disk diffusion and E-test were per-formed to detect the antimicrobial susceptibilities of those strains.The modified Hodge test, ethylenediami-netetraacetic acid ( EDTA) disk synergy test and extended-spectrumβ-lactamases ( ESBLs) confirmation test were used to screen out the carbapenem-resistant phenotypes.PCR analysis and gene sequencing were used to analyze drug resistance genes, genetic structures surrounding the blaKPC-2 gene and seven house-keeping genes of Klebsiella pneumonia ( K.pneumoniae) strains.The sequences of the seven house-keeping genes were analyzed with multilocus sequence typing ( MLST) .Pulsed field gel electrophoresis ( PFGE) was per-formed for homology analysis within the same species.S1-PFGE in combination with Southern blot analysis was used to determine the location of carbapenem resistance genes.Results A total of 19 Enterobacteriace-ae isolates with reduced susceptibility to ertapenem were screened out.Each of them was resistant to multiple antibiotics and harbored several resistance genes.Seven genes including the blaKPC-2 , blaIMP-4 , blaSHV-1 , blaCTX-M-65 , blaCTX-M-15 , blaTEM-1 and rmtB genes were the prevalent drug resistance genes.Fourteen out of the nineteen strains were identified as K.pneumoniae strains, mainly belonged to the ST11 type according to the results of MLST.Among the nineteen strains, eleven K.pneumoniae isolates and one Escherichia coli isolate carried the blaKPC-2 gene, located on plasmids varying in size (95 kb, 140 kb, 200 kb and 240 kb) .The ge-netic structures of all isolates were ISKpn8, blaKPC-2 and ISKpn6-like from upstream to downstream.The blaIMP-4 gene was detected in one Klebsiella oxytoca isolate and one K.pneumoniae isolate, located on a plas-mid about 300 kb in size.Conclusion Carbapenemases KPC-2 and IMP-4 were closely related to the car-bapenem resistance in carbapenem-resistant Enterobacteriaceae strains isolated form the Fuyang First People′s Hospital.No predominant clone was found in those carbapenem-resistant K.pneumoniae isolates.

AIM:In podocytes , autophagy occurs at a high basal level and dysregulated autophagy is associa -ted with a variety of podocytopathies .This paper is to investigate the role of autophagy in sublytic C 5b-9-induced podocyte injury.METHODS: Sublytic complement C5b-9 stimulation was used as an in vitro model.Autophagosomes were con-firmed using monodansylcadaverine (MDC) staining.Immunoblotting was used to measure the change of autophagy-related markers.Cellular morphological changes were observed by Wright-Giemsa staining.Immunofluorescence staining and con-focal microscopy were used to detect the expression and distribution of nephrin .The cell viability was assessed by methylth-iazol tetrazolium (MTT) assay.The cell apoptosis was assessed by Annexin V-fluorescein isothiocyanate/PI staining.RE-SULTS:For ensuring sublytic complement injury , the maximal amounts of anti-podocyte antiserum and 160 ×-diluted nor-mal human serum were used without inducing cell lysis (defined as >5%LDH release).Sublytic C5b-9 promoted autoph-agy of podocytes in vitro.The proautophagic effect of sublytic C 5b-9 manifested in the form of accumulated MDC-labeled vesicles and enhanced the expression of LC 3-Ⅱ.Autophagy inhibitor 3-methyladenosine (3-MA) promoted sublytic C5b-9-induced podocyte morphological abnormalities .Compared with the sublytic C5b-9-injured podocytes, 3-MA exposure further decreased the expression of nephrin .3-MA enhanced sublytic C5b-9-induced podocyte apoptosis .CONCLUSION: Sub-lytic C5b-9 attack induces autophagy , which may play a protective role against complement-mediated podocyte injury .

Objective To observe the efficacy and adverse reactions of ECF regimen (epirubicin combined with cisplatinum and fluorouracil) and DOF regimen (docetaxel combined with oxaliplation and fluorouracil ) in the treatment of advanced gastric cancer .Methods 68 cases of advanced gastric cancer were randomly divided into the ECF group (30 cases) and the DOF group (38 cases) .The ECF group was treated with epirubicin 50 mg/m2 on 1 d ,cisplatin 20 mg/m2 on 1-3 d and fluorouracil 500 mg/m2 on 1-5 d .The DOF group was treated with docetaxel 75 mg/m2 on 1 d ,oxaliplatin 130 mg/m2 and fluorouracil 500 mg/m2 on 1-5 d . 21 d were as a cycle of treatment .All cases received two cycles of chemotherapy at least .The efficacy and toxicity were evaluated according to the WHO standard .Results All cases were evaluable for the objective response .The overall response rate was 46 .67% in the ECF group and 42 .11% in the DOF group .The major adverse reactions in the two groups were marrow depression , gastrointestinal reaction ,alopecia and neurotoxicity ,etc .The occurrence rate of neurotoxicity in the DOX group was 39 .47% (26/38) ,which was higher than 13 .33(4/30) in the ECF group ,the occurrence rate of nausea and vomiting in the ECF group was 93 .33% (28/30) ,which was higher than 68 .24(26/38) in the DOF group ,the difference between the two groups was statistically significant (P<0 .05) .Conclusion Both of the two regimens have the similar effect for treating advanced gastric cancer and the ad‐verse reactions are tolerable .

Objective To investigate the role of autophagy in podocyte damage,and the intracellular mechanism of autophagy activation through passive Heymann nephritis (PHN) animal model.Methods Male Sprague-Dawley rats (n=40) were studied on day 0,2,4,7,and 21 after induction of PHN by injection of anti-Fx1A.Podocyte morphology and autophagosomes were observed by transmission electron microscopy.Podocyte numerical density was estimated by Weibel-Gomez =method.Cell apoptosis was detected by TUNEL assay and caspase-3 immunohistochemical staining.Expressions of autophagy markers and endoplasmic reticulum stress (ERS)-associated proteins were analyzed by Western blotting.Results (1) In PHN rats,immunohistochemical staining showed that C5b-9 deposited along glomerular basement membrane on day 4 to day 21.Small subepithelial electron -dense deposits and a part of foot process fusion were detected in the glomerulus of PHN rats on day 4 by transmission electron microscope,and podocyte damage was aggravated on day 21.Furthermore,compared with control,the urinary protein levels of PHN rats began to increase on day 3,and reached the top on day 21 [(50.6±6.0) mg/24 h].(2) The number of podocytes significantly decreased in PHN rats compared with control group on day 21(P ＜ 0.05).(3) In PHN rats,apoptotic podocytes were found by caspase-3 immunohistochemical staining and TUNEL assay on day 21.(4) The expression of autophagy marker LC3 Ⅱ was markedly increased on day 7 and 21,but down-regulated on day 21 compared with day 7.Moreover,accumulated autophagosomes in podocytes were detected on day 7 and 21 by transmission electron microscope.(5) The level of GRP78 was significantly increased on day 2 and 7 but reduced to baseline on day 21.At the same time,the downstream pathways (ATF6α,p-PERK and p-JNK) of unfolded protein response were also up-regulated in the early process of PHN and down-regulated later.Conclusions Autophagy is an important way to protect against immunemediated podocyte injury in membranous nephropathy.Autophagy activation is mainly related to endoplasmic reticulum stress induced by complement attack.This provides an important basis for a thorough understanding of the role of autophagy in the process of podocyte damage and the pathogenesis of membranous nephropathy.